This is a thread for practical advice for preparing for the coronavirus in places where it might substantially grow.
We'd like this thread to be a source of advice that attempts to explain itself. This is not a thread to drop links to recommendations that don’t explain why the advice is accurate or useful. That’s not to say that explanation-less advice isn’t useful, but this isn't the place for it.
Please include in your answers some advice and an explanation of the advice, an explicit model under which it makes sense. We will move answers to the comments if they don't explain their recommendations clearly. (Added: We have moved at least 4 comments so far.)
The more concrete the explanation the better. Speculation is fine, uncertain models are fine; sources, explicit models and numbers for variables that other people can play with based on their own beliefs are excellent.
Here are some examples of things that we'd like to see:
It is safe to mostly but not entirely rely on food that requires heating or other prep, because a pandemic is unlikely to take out utilities, although if if they are taken out for other reasons they will be slower to come back on
One piece of information that has been lacking in most advice we’ve seen is when to take a particular action. Sure, I can stock up on food ahead of time, but not going to work may be costly– what’s your model for the costs of going so I can decide when the costs outweigh the benefits for me? This is especially true for advice that has inherent trade-offs– total quarantine means eating your food stockpiles that you hopefully have, which means not having them later.
Since COVID usually kills via pneumonia, and insufficient vitamin D appears to be a surprisingly large risk factor in respiratory infection, it’s probably pretty important to keep vitamin D levels sufficient (which in most people means supplementing it specifically, esp if there’s any quarantine that affects food).
There’s also the bad news that multivitamins mostly don’t do anything. There has not been found an alternative to eating a variety of nutrient-dense whole foods. Though vitamin D supplementation appears to be quite beneficial.
Good call, these are indeed useful, though I'm not sure if worth it. Guessing 20 mins total for vitamin D for a 3x decrease in 10% of the population is roughly a 7% risk reduction, while maybe 10 hours on the spirometer for a ~~3% effect? (Eyeballing this study in pneumonia sequelae looks like an 80% effect from this over 2 years, plus other interventions.) If this thing on average knocks 2 months off my life, a 3% effect is still 2 days, plus you get other health benefits, BUT if I'm planning on quarantining hard enough to not get it, the benefits do go down.
I'm leaning on the expected value rather than robust evidence.
Definitely seems plausible to me that it's not useful for immune function outside bone health. But priors (it's the one vitamin not in diet, so everyone is deficient) and the small amount of evidence are enough to make me think it's net-positive, and even 20% likely to help by a small amount is a relatively large benefit (~ a day of life).
It seems hard enough to find small effect sizes of things via study that I'm not at all surprised meta-analyses showed no evidence for it—and when I don't really expect to see evidence, defaulting to "do what seems like it would be healthy in the ancestral environment" says sunlight is probably a better bet than supplements, but being non-deficient in vitamin D is probably a better bet than being deficient. (And again, this doesn't apply to other vitamins because they're in the diet. It does apply to e.g. sleep and exercise though.)
You can get vitamin D from sunlight exposure. For white people, this doesn't take long, probably minutes (around noon) of direct exposure on your face and arms. If your skin is darker, it takes longer. You have to expose more skin for longer periods. Black people maybe can't get enough at high latitude and will have to take the pills. If you're supplementing this way, you do have to actually step outside for a bit. Exposure through windows that block UV is not going to work. Obviously, sunscreen will prevent some exposure.
If you get a sunburn, you waited too long. You have to factor in season, latitude, time of day, and skin tone. There's an app called dminder that can help you time it so you don't get the sunburn.
Is there any reason to worry copper tape might be less effective than the copper used in experiments? (I haven't read methods to see if they describe the source of the copper) For example, a lot of copper is designed to be resistant to oxidation - does that matter?
In photos of Amazon fulfillment centers, the workers appear to mostly be wearing fabric work gloves, not disposable gloves. Workers touch both the outer cardboard box and the item; but if the item has its own packaging, anything inside of that will probably have been untouched since manufacture, which is probably long enough.
What I know from clean rooms in the biopharmaceutical production is that you avoid there cardboard at all because there is no straightforward way for disinfection (besides the particulate contamination that comes with them). Therefore, one approach is to remove the cardboard as soon as possible and put it away (and wash your hands afterwards).
Edit - Additional comment to make the statement more precise:
There is no straightforward way for disinfection of cardboard without destroying it, i.e., the cardboard soaks in the cleaning agent and will disintegrate.
Do you mind elaborating on how you reconcile your model with the 1st CDC link you list in your research? "In general, because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from products or packaging that are shipped over a period of days or weeks at ambient temperatures" And my interpretation of the 2nd JHI link is that since cardboard is perhaps closest to wood/paper, then the persistence is about 1-4 days, which seems to indicate a relatively low risk (at least compared to other surfaces). I think taking your advice is reasonable because it only increases safety; I just wanted to better understand what we think the risk level is.
2. The CDC is talking specifically about infection from China (I assume this was written when CoV was more contained), and I agree that typical transit time from China is long enough to let the virus die. I'm specifically concerned about the delivery person and the dude at the Amazon warehouse who packed the box.
Use hand sanitizer or wash hands with soapy water frequently- after touching any doorknob exposed to an epidemic, at a minimum. (This includes doorknobs that only you touch, if there's a chance that you're in an infections asymptomatic state). Other triggers include the normal cases of before cooking and before eating.
Tl;dr Putting copper tape on commonly-touched surfaces is a high-value thing to do in the case you’re actively trying to avoid infection, since copper kills viruses and ~~50% of viral disease is from hand-to-surface-to-face contact (h/t Adam Scholl for hypothesis) [ETA: coronavirus seems to have mostly (?) respiratory droplet transmission, so this prior is less relevant but still worth intervening upon]
Amazon link (sadly, probably one Amazon item that won’t go out of stock)
Metals killing bacteria is well-documented, like all the very consistent results in this paper comparing 9 metals (lead kills slightly better than copper but that unfortunately extends to the humans; zinc and some other metals also kill pretty well, only two did not). Within an hour, copper dropped CFU from 10^6->10^1 (the measurement threshold). Zinc took 2 hours, nickel 4.
Unfortunately, this isn’t in widespread use in hospitals yet. But when it does, copper on the most-touched surfaces of an ICU appears to reduce infections by about half (bed handles, chair armrests, nurse call buttons, and a few others). But these are in very high-germ-load environments. What happens in a normal home?
First, how much of disease spread is from hand-to-surface vs airborne or hand-to-hand? I lost the citation and it wasn't well backed, but apparently you don't catch colds through suspended particles very often (someone has to sneeze within 6 feet or exhale in your face lots). And hand-to-hand contact spreads it more efficiently but (one paper said) less frequently than hand-to-surface-to-hand, especially in environments without lots of high-fiving and hand-shakes. Plus, the study saying 50% infection reduction from copperizing main surfaces would fit well with a base rate of ~70% hand-to-surface infections and, of these, ~70% of touches in the ICU got sanitized by the dangerous surface metal coverings. But 70% sounds like a lot so I’m going to be a little conservative and just say 50%.
Now, it’s hard to figure out how many things you’d need to cover with copper to reduce most of this. But some typical commonly-touched shared items are:
doorknobs (brass is probably ok, steel is not) [ETA: comment below points out brass not ok]
backs of chairs
Depending on how many people you are sharing touch-space and not air-space with, I expect covering these in copper could reduce infection by anything from 1 to 50%, though I expect in a typical house of four people who sometimes venture outside and don’t know about never touching your face, you’d get an effect roughly between 15 and 40%.
This study describes "detecting viable virus" as having a threshold of 10^0.5 TCID50/mL, and they assume exponential decay of viable virus particles.
I'm really confused by their numbers, tho; it looks like cardboard has a hundred-fold reduction in 23 hours, from 10^2.5 to their detection threshold of 10^0.5, which I can't square with the 8.5 hour half-life. [Edit: it looks like I'm potentially confused about what TCID50/mL means?]
I also don't know how to compare their detection threshold with the point at which I should be willing to handle a cardboard box (with varying levels of cleaning and PPE). Is their test basically as sensitive as my immune system (in that I shouldn't handle something where they could see a viable virus, and can handle something where they can't)? Or should I be letting boxes sit for 3 days?
Worth noting that a lot of metal handles will be coated with a finish that prevents you from actually touching the metal. This is because these metals (especially copper) can leave a strong metallic smell on your hands which people typically dislike, and also because it prevents the metals from tarnishing. These handles will not help reduce infection and will need copper tape on them.
Sorry, forgot to modify this for a virus-specific claim, but yes.
On solid copper, H1N1 decreased by 4 logs in 6 hours in this review; vaccinia and monkeypox viruses were reduced by 6 logs in 3 minutes in this study; murine norovirus was destroyed in 30 minutes in this study, though it doesn't work very well at 4C; and another review says that copper oxide filters neutralize all of "bacteriophages [58-62], Infectious Bronchitis Virus , Poliovirus [61,64], Junin Virus , Herpes Simplex Virus [58,59], Human Immunodeficiency Virus Type 1 (HIV-1) [11,65-67], West Nile Virus , Coxsackie Virus Types B2 & B4, Echovirus 4 and Simian Rotavirus SA11 . More recently, the inactivation of Influenza A [55,65], Rhinovirus 2, Yellow Fever, Measles, Respiratory Syncytial Virus, Parainfluenza 3, Punta Toro, Pichinde, Adenovirus Type 1, Cytomegalovirus, and Vaccinia ".
Wikipedia suggests copper can kill at least influenza A virus and adenovirus. It seems likely that it would be effective against other viruses too, though not clear (to me) if it would work against every virus.
This ERI review concludes that there was really only one RCT (the one you linked), and they found that the study didn't actually reach significance
Our calculation found that the difference in the HAI rate (regardless of MRSA/VRE colonization status) between the study groups was not significant (copper-equipped ICUs: 17/294 [5.8%] versu snon-copper-equipped ICUs: 29/320 [9.1%]; p=0.123). The median length of stay for both groups was four days (p=0.74). The reported mortality rate was 42/294 patients (14.29%) in copper-equipped ICUs versus 50/320 (15.63%) in non-copper-equipped ICUs(p=0.64).
What's going on here is that Salgado splits outcomes into 4 groups, nothing, infection, colonization, and both, and finds a difference between the 4 groups. The review says "I only care about infection" and compares infection vs non-infection, and finds no significance. Each version of their math checks out, but I'm inclined to trust the review here.
If it's a cheap countermeasure that aims, in the better estimate, for a 50% reduction of a small risk I think you'd be better off asking yourself if you'd buy it at double price rather than deciding which of the equally persuasive, conflicting experimental evidences about its efficacy you should trust. Also if you're worried about non monetary costs like hand skin damage, I guess you'd better decide if you'd put up with the same cost for a 25% risk reduction.
Earlier I heard something like "wrinkles in the copper can reduce the effect, something something the fluids get caught in little pockets and leave spots that don't touch the copper."
Have you heard anything about that and have any thoughts on that? A lot of the images I see of people coppering their doorknobs are particularly wrinkly, and I'm wondering how much effort to put into getting everything smooth.
Because 'spamming' is a rude way to force people to pay attention to you, and should be discouraged. But posting the information in ways that follow community norms seems good, although I'd want to think a bit about prioritising messages to spread - quite plausible to me that advertising the need for expanded capability to supply oxygen to people is more important.
This is a good point, but for what it's worth I don't fully endorse coppering your phone (mine isn't coppered). Several people have anecdotally reported it being uncomfortable or irritating on their hands, or receiving tiny cuts from the copper, etc.
Absorption through skin is incredibly low, but I do take the risk of open (if tiny) hand wounds seriously, and also generally try to reduce my total copper contact in case anything weird does happen, since this is not tested by time.
But if you are constantly handling your phone it will reduce the value of frequent washing/sanitizing of hands, since anything you do get on your hands will transfer to your phone.
Although, I don't know what the numbers look like for transferring virus when a touch occurs -- e.g. if we look at a path like "handshake -> touch phone -> [wash hands] -> touch phone -> touch face", how much of the virus is left after four sequential touch events like that? Perhaps this kind of secondary contamination is not actually a huge deal? I have no idea.
A powder called Glo Germ, meant to visualize germ spread, was still visible to the naked eye after 8 handshakes (but not 9) in an informal experiment by YouTuber Mark Rober. ( https://youtu.be/I5-dI74zxPg?t=346 )
Edit: Sounds like this isn't very useful because you'll be able tell if you're having trouble breathing? See comment below.
Advice: Get a pulse oximeter to be able to triage at home.
Reasoning: If you're mildly sick, you probably don't want to go to a medical office (both because you'll be clogging up an overcrowded system, and because you'll be around people who are even sicker). But you need to know when you're sick enough to need medical care.
One way medical professionals triage is by vital signs. Most of them are obvious either to you or to other people (shortness of breath, paleness, dizziness, turning blue) but oxygen saturation (how well-oxygenated your blood is) is not. If you think you might have pneumonia (one of the common effects of coronavirus), low oxygen saturation is one of the things that would indicate that, and lower numbers should move you toward getting medical care. 95% and above is normal (at sea level) and lower numbers mean it's likely your lungs aren't working properly (with outcomes being worse the lower the number is).
The device is cheap and easy to use.
Note that you might still be very sick and need medical care even if your oxygen level is fine, so this is a way to rule in being sick enough to need medical care but doesn't rule it out.
(I'm not a medical professional and would appreciate it if someone who is would double-check the logic here, or some risk I'm not thinking of in terms of people reading it wrong and coming to wrong conclusions)
TL;DR. If you have (slightly) low PaO2, but no trouble breathing, you probably don't need to go to the hospital. And if you have trouble breathing, you should probably go to the hospital whether or not you have low PaO2. So testing for oxygen saturation doesn't add much.
I had an online conversation with an intensive care physician. I sent him a translated version of juliawise's text and he said he didn't think buying the pulse oximeter would help and then sent me a 5 minute audio explaining why. The following text is his audio translated from Portuguese to English, I hope there are no wrong translations and I changed my mind after listening to him. Please also share what you think about his response:
"All pneumonia will desaturate the patient. O2 saturation is related to perfusion (gas exchange). Patient with acute respiratory syndrome (inflammation of the lungs by viral or bacterial infection) may course with poor tissue perfusion, that is, inadequate tissue oxygenation. One way to evaluate this is pulse oximetry, PaO2.
Patients with respiratory discomfort due to lung inflammation may or may not present desaturation. PaO2 < 90 indicates oxygen therapy. But perfusion and ARDS severity should be evaluated by the PaO2/FiO2 ratio (serum O2 concentration/offered amount of O2) to maintain good oxygenation.
What takes the patient to the emergency room is not the oxygen saturation level. You won't see a patient say "I'm feeling bad, let me see my saturation level" and suddenly find 80 or 85. If you start running and put the oximeter on your finger you can easily find 91~92.
What takes the patient to the emergency room is respiratory distress. He will feel shortness of breath and we will evaluate this with the methods of severity assessment, which would be oxygen saturation. And we would see in more severe patients a value below 90%.
The clinical picture of pneumonia is coughing, shortness of breath, respiratory discomfort, pain and by doing an x-ray he will detect a pulmonary opacity. You'll see a white field, where there should be air, there'll be fluid. Then you diagnose pneumonia.
The medical reasoning is this: I think about pneumonia based on the symptoms, I observe the saturation and it correlates with pneumonia, I see the x-ray and it correlates with pneumonia so I start the protocol... actually when I do the physical exam and I think "ah, it's an acute respiratory distress syndrome" I don't even want to know what it is initially, I want to offer oxygen, guarantee the airways, improve the gas exchange and keep the patient alive until finally I can test for coronavirus.
In fact, the saturation will indicate a marker of severity in a dyspneic patient. Not a diagnostic marker. There is no way to observe a patient who is desaturating and give a diagnosis for coronavirus.
Many things change oxygen saturation. Like I told you, oxygen saturation measures the amount of oxygen inside the RBC, right? So if I have a RBC with low hemoglobin inside, like with an anemic patient, it changes the oxygen saturation. If the patient is not doing good gas exchange, it changes the oxygen saturation. For example, lowering of consciousness will give low saturation. Also if he is shocked, hypotensive or hypothermic. Another thing that also changes is the use of enamel on his fingers. "
Then I sent him an audio saying:
Me: "I got it. But let's suppose we were in the following situation: there are 10,000 infected in the city, the government starts to declare quarantine. Suppose you're home with a fever and another symptom like cough. You're left wondering, "Should I go to the hospital and test for coronavirus?" But knowing there is an outbreak and that the hospital is crowded with people with the disease, chances are you will get the disease when you go to the hospital if you don't have it. I am at home, isolated because I have the symptoms of the disease, but I am not sure if I have coronavirus and I do not know if I should really go to the hospital. How do I know if I should really go to the hospital? Should I wait until a respiratory problem like difficulty to breathe starts to appear? Is it possible that I take the measurement with the oximeter and it gives a low oxygen saturation before I even start having a breathing difficulty?
He: "Not under normal conditions. Under normal conditions, a patient with only a cough, fever, runny nose, or an upper airway condition will not change oxygen saturation. That wouldn't make you think about going to the hospital, you'd stay home, like you did every time you had a common flu picture.
Even because you will not change the treatment. You will be treated as supportive therapy like all viral infections: H1N1, etc. But if you stay home without any signs of severity, it will resolve as if nothing had happened and the diagnosis would not be closed, you know? It would be a syndromic diagnosis... a flu picture, a common flu without any complications. What happens is that in the face of the epidemic, people are testing coronavirus for patients with acute respiratory syndrome, respiratory discomfort. Then, for fear of serious evolution, these patients are tested [for coronavirus] for early ventilatory support."
Then I sent him this text message:
Me: "1) Fever → coughs → respiratory discomfort → recommend going to hospital to test for ncov and receive early ventilatory support.
Would the mistake in my reasoning be to assume that there would be low oxygen saturation before even presenting respiratory discomfort?"
Thinking about it, now I believe if I have Fever → coughs → respiratory discomfort or shortness of breath → I should go to the hospital.
If I have Fever → coughs → NO respiratory discomfort and NO shortness of breath → check oxymeter and low PaO2 → Do not go to the hospital.
So having the oxymeter wouldn't make me go to the hospital. So I don't need an oxymeter.
If you have (slightly) low SpO2, but no trouble breathing, you probably don't need to go to the hospital. And if you have trouble breathing, you should probably go to the hospital whether or not you have low SpO2. So testing for oxygen saturation doesn't add much.
Is there any info the comment was meant to convey that that leaves out?
According to this NYT article, Covid pneumonia often (in most cases?) initially causes low blood oxygen without obvious respiratory discomfort or shortness of breath ("silent hypoxia"), and early detection of this can be critical. If true, it is a very strong argument in favor of pulse oximeter.
It seems to me that the usefulness of a pulse oximeter depends on the progression of the disease. If "low osat" comes before "fever etc", then a pulse oximeter would help you move from "low osat → fever etc. → see a doctor" to "low osat → see a doctor → fever etc.". But if "fever etc." comes first, I would think you would be at "fever etc. → see a doctor → get osat measured" regardless of whether you have a pulse oximeter, and so I don't see how the pulse oximeter would be useful.
This is useful in case you have facing a choice of riding it out at home and going to a hospital with high probability of getting infected if you're not already. E.g. if you have fever chances are still high you're just experiencing regular flu, and should not go to the hospital, but if your oxigen starts dropping into the danger zone you need to go.
There seems to be a general variance in what pulse oximeters display when measuring healthy individuals with readings from 94% - 100%. I also seem to remember reading that they are sensitive to altitude, whether hands are cold etc (n.b typing on phone, can't verify at the mo)
Talking to a doctor friend -- in clinical settings if an oximeter shows a reading < 90%, it's considered serious, but different people respond differently, but closely enough for the purposes of this discussion to fall into two groups. Either you develop a shortness of breath by the time its at 92%, for eg., and you have to go an ER anyway. Or you feel fine, but have less than 90% reading and you'll end up going to the ER (because you've looked at the range of normal measurements)
If the suggestion of use of the pulse oximeter is supposed to be a diagnostic about whether you need to go to the ER or not (and thus avoid picking something up at the hospital), it doesn't seem to help? It also doesn't tell you anything specific to Covid-19, I mean, you could be short of breath for a variety of reaons (note: short of breath sustained for many minutes, not the kind where you are panting after climbing stairs for eg.)
The logic is to "save you a trip to the doctor, or to support remote care via phone/video chat. " Recommended diagnostic tools are digital thermometer, finger oximeter, blood pressure cuff, and stethoscope for lung sounds.
In order to avoid cross infection, it is a good idea to use telemedicine rather than emergency room or doctors' offices.
Suggestion: research options for video chat, text messaging, or emailing doctors. Once you start to show symptoms, take critical measurements at regular intervals and log.
I saw an earlier recommendation and went to Amazon. They have pages of them, differentiated by color and style, which made me realize they are a commodity, in common use among a particular large population of at risk people. They're not covered by health insurance, so there's actual competition. Look at the ratings and use your usual yardsticks to pick ones that people who have bought before find to be reliable and useable.
You should have some kind of electrolyte powder or electrolyte drinks on hand. When sick with any disease that can cause a fever (Fever is one of the symptoms of COVID-19 that pretty much everyone gets), staying hydrated is possibly the most important thing for you to be doing. You may be losing fluids from sweating and you may not be paying much attention to how much you are drinking. You will do a better job staying hydrated if everything you need to be hydrated can be right next to your bed. Once you have a fever it will really suck to go acquire stuff and you should be staying at home anyway.
Don't bother with the drinks. Recommended home-made rehydration drinks usually are sugar + salt for electrolytes. You want ~12x as much sugar as salt, and if you want to prep early, you can store the sugar-salt mixture and add it to water - you want about a half tablespoon of the mixture pur cup of water.
Unless this is the only thing you have to eat/drink for more than a couple days, this is fine - no need for anything complicated or expensive. And if you're too sick to eat solids or other foods, I'd suspect you don't have COVID-19, you have something else.
Can you respond directly to the claims that potassium and magnesium are also useful? It seems like your implicit model is that people will definitely be able to eat and therefore those will not be a concern.
I'm not sure I understand the question, exactly. Yes, lots of things are useful, like vitamin D, Zinc, and Potassium - but they aren't important for preventing dehydration, and the WHO recommends using the above sugar + salt formula for home preparation, which is why I pointed out that it's recommended.
If you want to buy Soylent, or Gatorade, or anything else, go ahead, but if you're trying to prevent dehydration, there's no need to buy any specialized drinks.
Where does the 12x come from? The link mentions 1/2 a tablespoon of salt versus 2 tablespoons of sugar, which is a factor 4 in volume. A quick google says the densities only differ by 25% (and in the direction that makes the ratio closer, not further apart), so this is not mass percentage either.
EDIT: Never mind, they mention 1/2 a teaspoon of salt. My mistake.
I'm not sure if electrolyte powder is more hydrating than salt. . .
But I think there's a lot to be said for making water taste good enough to you that you want to keep drinking it. Often things taste worse than usual when sick and having something you can mix with water that tastes good will make you more likely to keep drinking it. For the same reason I try to have a variety of hydrating things I'm willing to drink around so when one gets old I can switch to a different one.
I am wondering this too. I think they contain more of the essential compounds we need need for our water/"salt" balance. Like, not just sodium and chloride as in table salt, but also maybe potassium and calcium?
Your blood normally contains around 140 mmol/L of sodium, and smaller amounts of calcium, magnesium, and potassium. Sodium is the most important of these and has the narrowest normal range (135-145 mmol/L). Except for calcium (which can be taken from your bones) there is little storage. In normal circumstances you don't lose much water and can get sufficient electrolytes from food, but during fever your fluid loss rate can easily be increased by multiple liters per day, and you may be eating much less as well.
Tl;dr: Not knowing much about this and not a doctor, my current policy is to go to a hospital if SpO2 drops below ~92% and my hospital isn’t completely overrun, unless my SpO2 is naturally low or some other extenuating circumstance. If I was forced to use an oxygen concentrator outside of a hospital, I would target a ~~94-96% SpO2 range, trying very hard to make sure I didn’t hit 99%
If you do have COVID and shortness of breath, when do you go to a hospital?
Hopefully you already have a pulse oximeter as Julia Wise recommends [LW(p) · GW(p)]. But sources say anywhere between 90 and 95% SpO2 is the threshold for hospitalization (WHO says <= 93% is classified as severe, ctrl+f “O2”), while other sources [LW(p) · GW(p)] say you should threshold on trouble breathing and shortness of breath, not the actual SpO2 number.
It seems to me that using “trouble breathing” as the indicator would track the lung blockages and thus immune response relatively well, while O2 as an indicator would track the danger metric directly (if in fact the primary source of death is insufficient oxygen; if anyone knows this, would be useful).
The benefit of looking at trouble breathing is that it’s an advance indicator. Usually people progress from oxygen therapy to ventilators relatively quickly. If you have naturally low SpO2, your O2 might drop under threshold (say, 93%) in the early stages with mild trouble breathing, but you wouldn’t have much of a dangerous immune response until later. In this case, you’d have wanted to use difficulty breathing as your indicator instead of SpO2.
That being said, having low oxygen seems pretty bad for you, both by common sense and science. For example, 92% or lower is associated with increased morbidity in pneumonia patients; <90% is increased with 36% increased morbidity. Since it’s hard to measure even moderate effects due to the treatment-correlated-with-severity [LW · GW] issue, my guess is that there’s some general bodily harm from reduced oxygen even at levels like 95%, though I don’t know how much. So at some SpO2 threshold, I think you want to be supplementing oxygen even if your breathing doesn’t feel that difficult.
Unfortunately, it seems like you can’t supplement oxygen at 95%, because over-oxygenating causes neuronal damage. Standard targets appear to be 94-98% or 92-96%. This study says it seems bad to set your target range during oxygen therapy to greater than 92-96%, because one inevitably exceeds the upper target occasionally. This review/musing muses that it’s a difficult problem, evidence for hyperoxaemia being pretty bad is “comparatively strong”, but not strong enough to warrant especially conservative oxygen titration. Because of these numbers, I think 92-93% is a reasonable threshold to self-hospitalize, since anything above this means they probably shouldn’t be oxygenating you anyways.
If hospitals are overloaded and you have to do oxygen therapy yourself (really try not to do this), I think the targets above are still reasonable, subject to your ability to titrate well with the machine. If you have lots of trouble, of course be conservative. However, you may be able to do better than hospitals: the first study above says that “even in a research setting in the intensive care unit, in which patients receiving mechanical ventilation are closely monitored, most patients who were randomized to an SpO2 target of 90–92% and were receiving supplementary oxygen did not have their inspired oxygen reduced if the SpO2 was 99% or 100%.” So—seems like you could easily do better monitoring than this if you were oxygenating at home. This is why I would probably shoot for 94-96% myself.
The aim of your quarantine procedure and other actions should be to delay your exposure to coronavirus until after the peak has passed. It is unlikely to be possible to delay it indefinitely, especially if we are going to have a return to normalcy.
With every epidemic there is likely to be a peak - a period of exponential growth, climaxing in a peak and then a slowdown. Your goal should be to get exposed after the peak period. During the peak, medical supplies will be stretched very thin and hospitals may be overflowing. After the peak, medical professionals have a lot of experience dealing with the disease and we will know the landscape of outcomes and treatments. As long as the medical systems are not destroyed by the virus, that may be the best time to get it.
I modeled a logistic growth equations for a population of 7 million (bay area) and different estimates of the doubling rate I found in the literature - for a doubling rate of every 3 days, the peak seems to come after about 2 months from initial exposure. For a doubling rate of every 7 days, the peak comes about 4 months after initial exposure. Since the virus has likely been circulating for several weeks already, we can predict the peak in the bay area is 1-3 months out. How it actually plays out will vary a lot based on containment measures, public events, lifestyle of the populace, etc.
This is all extremely speculative but gives me a goal to shoot for - before I was trying to figure out what is the goal of quarantine for myself, if I was ever going to rejoin society. Now I have a model for why I should avoid getting it.
Instead of a single peak moment, we want to think about "the time period during which medical supplies and services are overwhelmed with demand". And that starts, in my rough estimation, the moment all the hospital beds are full.
In the US, we have 3 hospital beds for every 1000 people, and 2 of them are occupied on average. So we're going to start having problems once 1 in 1000 people want to go to the hospital for coronavirus, which corresponds to an infection rate around 1%.
So that pushes the moment of great worry forward by quite a bit!
On the other side, it's hard to predict when supply will again overtake demand. Maybe governmental intervention comes through on a massive scale, maybe mass quarantine works, maybe the weather warms up and transmission declines. But I'm worried it will take months for any of those to happen after the crisis times begin.
I would modify your advice to "2 weeks before all the hospital beds are full (in your local region)", because 2 weeks is roughly the lag time between exposure and needing hospitalization (I think?). With exponential growth @ 5day doubling time, you really want to not catch it when 0.01%ish of the local population is hospitalized [assuming per-capita hospital beds in your region is typical of the USA]. My region has ~7M people, so I would be thinking about upping my social-isolation game when 700 people in my region are in the hospital, or something vaguely like that. Probably adjust that down quite a bit for uncertainty in the input parameters, and for not all cases being diagnosed (even in the hospital). Adjust down even more if lots of hospital staff are likely to get sick or quarantined because they're not taking appropriate precautions, which seems probable at the moment.
If 99%+ isopropyl alcohol becomes unavailable, it looks like the other common concentrations are 70% and 91%. Using 70% isopropyl alcohol and not diluting gives you 65% alcohol, which is below the 75% in the recipe-- anyone know if 65% is likely to be effective?
In that case you can use the straight 70 % isopropyl alcohol as a sanitizer and be fine. According to the WHO guidelines, only the isopropyl alcohol is the effective substance in the recipe. The hydrogen peroxide is ‘used to inactivate bacterial spores in the solution’. If you buy medical-grade 70 % isopropyl alcohol, there shouldn't be any bacterial spores in it.
The glycerol serves as a humectant. If you don't add it, you might have to use more sanitizer in order to keep your skin wet for the whole thirty seconds. And you'll have to keep your skin happy in some way separate from the sanitizing.
Normally something with AfA as justification would be moved to comments, but it's useful and extremely specific in ways that can still be the foundations for a good argument, so we're leaving it in answers.
[EDIT: enough has been learned since I made this model that it is now deprecated. I am now working from home, indeed 2 weeks after the answer was first composed]
A guesstimate model I made to determine whether I should stay home from work. Most of the innovation is in collecting guesses/gut feelings and then doing the calculations. Based on my guesses, I shouldn't bother working from home for a few months. [EDIT: for complicated reasons it's probably more like one month] [EDIT: after further adjustments, partly to parameters and partly to the structure, it's now like 2 weeks] https://www.getguesstimate.com/models/15212
Meta note: the costs of being isolated are roughly linear in how long you're isolated, but the costs of being in public are exponential in the regime where your chance of getting infected is small and proportional to the number of people who are infected. As a result, you'd rather self-isolate one week early than one week late. Given the model uncertainty in any modelling attempt like this, this means you probably want to be a bit more paranoid than the model suggests.
Model update: previously, the model wasn't including the possibility of a chain of length more than 1 of people infecting each other at work, ending with you. This increases the disease burden of attending work by a factor of 2.
Guesstimate model update: Number of days you want to wait until working from home is (unsurprisingly) very dependent on epidemic doubling time estimates. Fiddling with the distribution to basically update on reports of 1- or 2-day doubling times in some contexts, the model now says that I want to wait a month before working from home.
A non-obvious flaw in the model: the "number of days until you should work from home" distribution is using in its calculation samples from the "current dollar value per day of disease burden of attending work", rather than the mean as it should. There's no easy way to fix this, but this pushes that number lower. Note that this error doesn't affect the calculation of whether I should stay home right now. [EDIT: but it does turn "wait a few months" into "wait a bit over a month"]
A 2 weeks supply of food sounds like far too short a supply. The first case of 'atypical pneumonia' was noticed in Wuhan in late Dec. It is now late Feb. They have by now organized themselves in Wuhan to the point where all of the ill people are getting sent to 'local' (temporary) 'hospitals' and the 'local hospitals' are triaging and sending seriously ill people onto actual hospitals with the capacity to care for people who are seriously ill (like requiring oxygen). But this level of organization is a fairly recent situation. Even 2 weeks ago, sick people were literally walking to hospitals, because ambulances were swamped; they were being turned away from hospitals for lack of beds and supplies, and medical personnel to look after them; they were sitting in hospital waiting rooms for hours being cross exposed to other sick people, etc. So, even with massive efforts on the part of the government, it took about 2 months for them to get their act together in a real hot spot of infection. If you are unfortunate enough to end up in a similar type 'hot spot' to Wuhan, (but still live in a first world country) it probably won't take longer than 2 months for the government to get its act together, but I wouldn't assume they will do much better than that... so, if you are planning on buying a little insurance, I'd suggest that a 2 month supply of food, etc, is about minimum of what you would need to get through a (1st world) worst case scenario, rather than 2 weeks.
And a 3 months supply would probably be a better choice than a 2 month supply. It's not like Wuhan is virus free or anything close to it, today, 2 months in...
A 3 month's supply of food sounds crazy, and, true, you probably won't need it. But, it's almost cost free to supply yourself with it. No one at all is suggesting power outages. So, you can probably just stock up on food and supplies you normally use anyway, at least for frozen, canned, and non-perishable type things. That obviously won't do for stuff like milk and fresh fruits and salad stuff, so you'll have to make some substitutions there, but for most other stuff you should be OK if you just buy extras of things you normally buy anyway. The only cost is the inconvenience of buying it all at once, and finding a convenient place to stack it down until you need it.
I have read many reports from people in Wuhan and there is food in the grocery stores. Actually it seems like no currently effected area has a permanent food shortage - there is a run on the stores and then they are full after a restock. However, shopping requires you to leave your house so you will want to minimize it. I think people are over-focusing on food shopping because it feels actionable. You are right that there is almost no downside
Recommendation: cover the back of your smartphone in copper tape.
Reasoning: in addition to the reasoning for putting copper on all commonly touched surfaces, your phone is an especially good choice because of the "copper halo effect", in which copper ions move from copper surfaces to nearby surfaces (like, say, your hands), leaving them much less hospitable to microbes. [Edit: As MalcolmOcean points out, this mechanism for the halo effect isn't supported by the Wikipedia page below. I made a leap to this explanation without realizing it. That said, I do think that copper (and copper oxides) will get on your hands as a result of this tape, partly because I've seen my hands turning a bit blue.]
A downside is that your hands may turn slightly blue. [Also: See the comment below about uncertainty about how much copper you'll eat as a result of this; tldr: I don't know but I think it's probably fine]
[This is a signal boost for Lady Jade Beacham's response to Connor_Flexman, but the idea was originally introduced to me by James Payor]
Huh. This is quite important if true. Can anyone with a bit more physics/chemistry knowledge give an estimate for how long this will last on your hands, and how much coverage of your hands you will get? If this is a significant effect, it seems like a pretty useful piece of prep (copper on phones) that I am only just hearing about.
A thing I probably haven't thought enough about is, "how much this will impact your rate of copper ingestion, and is that very bad?" My guess is that this is less important than the effects on infectious disease; it seems like it would need to increase your copper consumption by 100x in order to produce major negative health effects (https://www.atsdr.cdc.gov/toxprofiles/tp132-c2.pdf). I may try to be virtuous and do a fermi on this later but also I'd welcome someone else trying to do it.
Edited to add:
The most obvious effect of having too much copper is gastrointestinal distress. So if you try this and have stomach problems, maybe stop.
The halo effect (section on wikipedia) didn't seem to me to be about ions... I figured it was just like how if we're nearby & I'm less likely to get sick, then you're less likely to get sick, separate from my sickness having any effect on your immunity.
Yeah, you're right that I imputed a particular mechanism that isn't supported by the Wikipedia page - thanks for pointing that out. I do still think that the ions-getting-on-things mechanism is part of the story, mostly because the reduction sizes are really large. This could indicate either (a) that most microbes end up on surfaces first via touch surfaces, and spread from there, or (b) that copper ends up on nearby surfaces. Or some of both.
In this particular case, though, I think it's quite likely (because I've seen my hands turn a bit blue) that in fact copper and copper oxides are getting on my hands as a result of the tape.
I would much rather rinse a mobile phone regularly if it is water-proof (an increasing number is!) than use copper tape, although I would not use soap on the screen, to preserve its oleophobic properties; alternatively, if I were in a very susceptible group or if the virus were much more dangerous to me, I would find it more effective to put the phone in a plastic bag and either exchange it often or wash it as often as my own hands.
The thought process here is that copper tape cannot be applied to screens, which can end up very close to faces, but washing with soap is effective.
According to the CDC the coronavirus is thought to spread similarly to how the common cold spreads: person-to-person spread, and contact with infected surfaces or objects. There are certainly ways to get out of the house without coming in close contact with other people and without coming into contact with surfaces that others have touched. For example, going for a walk or a bike ride. (In densely populated cities this will certainly be harder.)
Furthermore, socializing with friends who you trust shouldn't be too risky. From the CDC:
People are thought to be most contagious when they are most symptomatic (the sickest).
Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.
So then, if you know/trust that your friends are asymptomatic, and you trust that they are hygienic (wash their hands, wipe their counters, etc.), socializing with them shouldn't be too risky.
My first thought is that with the coronavirus, our risk tolerance is much lower, and even if the data point applied to the coronavirus as well, 1/16 still isn't great. So if it makes sense to take the precautions of washing your hands after touching surfaces that others have touched, it probably also makes sense to avoid kissing people.
My second thought is that when you're kissing people it's probably going to be people you know personally and trust to be asymptomatic. But people can have the disease and be asymptomatic for weeks, so I'm not sure how much that helps.
Part of me is surprised about how little evidence there is of asymptomatic transfer. Either it's not frequent, evidence is hard to gather, it's not worth mentioning/publishing after a certain point, something else?
A discussion / recommendation on handwashing versus sanitizer would be most welcome, I think. I have seen recommendations ranging from "always wash hands if possible, use sanitizer only if handwashing is not possible" to "use hand sanitizer unless your hands are visibly dirty, in which case wash them."
I am a bit concerned that applying lotion after handwashing is potentially a good way to re-contaminate your hands, unless you and everyone in your household is very careful about how you handle the lotion.
(I seemingly managed to give myself irritant contact dermatitis from overaggressive handwashing after the first few days I started doing it a lot; the backs of my hands became red and painful. I feel like the amount of handwashing it took to cause this was a lot less than I expected. I may have made it worse by using excessively-hot water, but I might also just have unusually sensitive skin.)
I've heard but have not researched that within the range of water temperature a human being can stand, the temperature isn't contributing anything to the anti-microbial effects. So colder water for more handwashing or less irritation might be free money.
CDC advises alcohol based sanitizers at least in clinical settings, IFF your hands are visibly clean - since it's more effective in that case, and less drying. (Note: it does not help if you have actual bits of dirt on your hands.)
I thought this too, and then I read that coronavirus is an "enveloped virus" whose coating can actually be basically dissolved by soap & scrubbing:
PSA for non-science folks: Wonder why everyone is emphasizing hand washing? Sounds banal, but soap really IS an amazing weapon that we all have in our homes. This is because coronavirus is an "enveloped" virus, which means that it has an outer lipid membrane layer. Basically, it's surrounded by a fat layer. Washing your hands with soap and water has the ability to "dissolve" this greasy fatty layer and kill the virus. I'm told singing "Happy Birthday" twice is approximately how long we should all be scrubbing our hands with soap.
On reflection, I don't have a source I deeply trust for this. The quote above is from this tweet by a Johns Hopkins prof. Consider this a jumping off point for further investigation.
It looks like the lipid envelope is a feature of many viruses, including all influenza viruses:
The influenza virion (as the infectious particle is called) is roughly spherical. It is an enveloped virus – that is, the outer layer is a lipid membrane which is taken from the host cell in which the virus multiplies. Inserted into the lipid membrane are ‘spikes’, which are proteins – actually glycoproteins, because they consist of protein linked to sugars – known as HA (hemagglutinin) and NA (neuraminidase). These are the proteins that determine the subtype of influenza virus (A/H1N1, for example).
So I'd think that applying lotion and then, say, opening the bathroom door with lotiony hands will re-contaminate your hands. Doing it just before sitting at your desk for a while or going to bed might be a better time, so your hands can dry when you're not going to be walking around touching stuff.
I wonder about dryness and its effect on immune cells. Dryness can also kill certain immune cells, which can ultimately lead to a better environment for germs than if you had left the wound moist. My original source for this is a book on historical medicine that I can no longer remember, but a 20 minute literature check finds that modern wound care emphasizes keeping wounds moist (but not too moist, and not in all circumstances), both to prevent infection and promote faster healing:
The German equivalent of Consumer Reports believes this to be the best hand soap product that's currently on the market in Germany in the class of products that aren't specifically antibacterial.
For me that means there's no reason to believe this product is worth at keeping my hands clean. Using soap that's antibacterial seems to be a move that's bad for the commons as far as building up antibacterial resistance goes. Do you disagree there and think everyone should use antibacterial soap?
If the local case rate is not yet high enough to warrant quarantine, and you're hosting or attending events, then in addition to asking people to not come if they are sick or coughing, you also might want to implement fever screening.
Three studies of nCoV symptoms cited here found fever in 83%, 98%, and 98.6%. Studies are less precise on the exact timing of symptom manifestation, but fever appears to show up early. To screen people for fever, you need either an oral thermometer plus disposable probe covers, or a contactless infrared thermometer. A contactless thermometer is faster, but less reliable; if you use one, you will want to also have an oral thermometer plus probe covers to deal with false positives.
You put a disposable cover over on it, eg these, which covers the part that goes in peoples' mouths. So the main risk is that everyone is touching the same object with their hands. You can mitigate that by also having them wash their hands or use hand sanitizer afterwards.
For me personally, self quarantine seems pretty unnecessary at this point, but I would act differently if I were in a different age group. Given the below death rates I would self quarantine if I were over 40. I would like to note I expect these death rates to be somewhat high because they are largely based on confirmed cases, which I expect to be disproportionately the worse cases that ended up in hospitals.
There was one case of Covid-19 in Solano county (CA) that couldn't be traced directly to travelers, which indicates community spread may be happening and Covid-19 may be spreading in the bay area.
Note that while your personal survival is quite important, getting infected and surviving can have quite awful effects. We don't know what the long-term effects are like yet (because we haven't hit the long-term yet), but I won't be surprised if post-viral fatigue is common.
Being ill is also unpleasant, and you become a risk to your community, and especially any elderly people in your community.
These numbers are applicable when there are hospital beds and equipment and staff to treat the 20%ish of severe cases. When the hospitals get overwhelmed, the fatality rates will go up. By how much? I have a guess broken down by age here [LW(p) · GW(p)].
Great table to offer. Might be good to also update on some related state. Males seem twice as likely as females to contract the infection (not positive here if that also scales with age or not)
Also, those with preexisting condition (heart, lung, other immune system taxing states) are also more likely to suffer more, and be among those dying than those who are generally healthy.
I think there was also a suspected link between smoking and higher risk if exposed to COVID-19. That is probably too correlated with the other preexisting health conditions that might be too difficult to say much.
Regarding smoking, it of course damages your lungs making you more vulnerable to lung problems, but there is new evidence that it may increase the expression of the protein the virus uses to gain access to your cells, making you more easily infected.
Consider that by quarantining yourself you're also protecting others from being infected (directly and indirectly) by you, some of whom may be in much higher risk categories. Given that we're still in the early stages of exponential growth, this seems quite significant.
Noting I am living in a group house and we are now being fairly strict in limiting outside social contact, using stored food or sterilization procedures for when we order things, and are putting more thought into our procedures going forward.
Doctor I talked to said that this was 30% of patients
You probably need around 5L/min of 90% O2, which theoretically requires a medical grade condenser that requires a prescription. I, however, see no reason why getting 5 normal O2 condensers that can deliver 1L/min of 90% O2 and connecting them all with Y junctions won't work.
[Edit: you can probably do with 4L/min of 70% O2, so you'll need 2 O2 condensers. This advice is mostly based on priors and like 20 minutes of research. The crucial point is that you'll likely need at least 2 O2 condensers]
These devices should all be relatively easy to use. Many people use a bipap for sleep apnea. Many people with respiratory problems have their own O2 condenser that they use. The capnometer I'm less sure of, but there should be a simple flow chart on what to do. If there isn't, I will make one by talking to doctors.
The reason you need the capnometer is because giving people too much O2 also has its own host of problems.
This model assumes that there is 0 hospital capacity and it's only for 1 person. Model also doesn't take into account reduce quality of live because of the chance of chronic fatigue syndrome. Model also assumes 20% chance of getting COVID, which is pretty low. Disjunctions are more probable, so the value goes up rapidly with more people, but has a max because it can only be used on one person at at a time.
Bear in mind that the probability that a 2nd person you care about getting COVID conditioning on 1 person you care about getting COVID is pretty high because the people you care about hang out together.
The total cost is about 2k for the bipap, 5 * 400 for the O2 condensers, and 1k for the capnometer for 5k total.
If you think that more than 10% of the world is going to get COVID, buying 1 such setup for like 20 people is an obviously correct move given the model.
Things to watch out for: cheap chinese models of both of these devices.
Edit: took Daniel Filan's suggestion of adding Y juntures and tubing to the first line.
Do you have any thoughts on where to buy a bipap and a capnometer? Can you get them without a prescription? Are they sold on amazon? If you or anyone else manages to get this to work (or even just starts buying supplies for it), I'd love to know where they obtained all their supplies and what they ended up needing.
I'm also interested in estimates for this number. I'm very confident that 4-5% is the right ballpark for total number of infected people who are going to need hospital care, but unsure about whether there's a lot of age-related skew or not. I've seen people say that hospitalization doesn't come with a large age-related skew, which would be alarming (for young people) indeed!
13.1% have severe disease [...] and 6.1% are critical. [...]
Severe cases are defined as tachypnoea (≧30 breaths/ min) or oxygen saturation ≤93% at rest, or PaO2/FIO2 <300 mmHg. Critical cases are defined as respiratory failure requiring mechanical ventilation, shock or other organ failure that requires intensive care. About a quarter of severe and critical cases [i.e. about the number of critical cases] require mechanical ventilation while the remaining 75% require only oxygen supplementation.
As far as we can tell, these proportions for severe and critical symptoms are at hospital admission. Mark I first made this estimate here [LW(p) · GW(p)]; we have updated downwards since then on estimates of untreated mortality on weak evidence that the current international strain is less severe than Hubei's, and slightly upwards as testing in China and other East Asian countries becomes more thorough with fewer additional mild cases than we thought.
Also note that the 70% mortality without a ventilator/o2 for critical cases was assuming the basic medical care of an overcrowded hospital, even if equipment is not available. Medical care for pneumonia is primarily supportive, but doctors I've talked to say there is significant risk of developing complications like sepsis that require admission. This introduces more uncertainty into our estimates due to the number of moving parts.
(EDIT: ignore this paragraph, it's not true) I've seen this discussed on another forum. Apparently, medical grade condensers require the patient to be put in a pharmacological coma so that their body doesn't fight all that air being shoved down their lungs. Makes sense since usually only stuff that's potentially harmful requires prescription.
Also, I've seen open discussions in at least one democratic country of confiscating privately owned condensers for the public healthcare. So if you end up buying some equipment, you will want to keep your mouth shut and perhaps use cash if possible.
I'm confused by what you mean by "medical grade condensers". AFAIK, the type of condenser I'm talking about just delivers high oxygen content air through a nasal cannula or a face mask. I think you might be talking about ventilation, which involves shoving a tube down the patients throat and forcing high oxygen air in and out of their lungs.
Could you point me to where those discussions happened? I'd be interested in seeing whether government confiscation is likely to happen and maybe if I can make it more probable in some way. (I think that government confiscated currently unused oxygen concentrators and distributing them to hospitals is probably a very good thing.)
If you develop a dry cough, do take cough drops and sip liquids to prevent yourself from coughing.
Reasoning: I've seen one doctor claim this is helpful because one of the causes of severity is how deep into the respiratory system the virus is able to travel. Apparently lower respiratory infections are more severe because the immune system has a harder time fighting it. Coughing tends to drive the virus deeper into the respiratory system.
When getting restaurant takeout or delivery, put the food in an oven and bake at at least 70C/160F for 30 minutes to kill the virus. To minimize contamination, I put the whole package containing the meal into the oven, wash my hands, then operate the oven. (This assumes that only the packaging and outside of the food is likely to be contaminated, because the inside is hot enough to kill the virus already. If this is not true for the meal you're getting, increase the oven temperature or time enough to thoroughly heat the food to 70C for 30 minutes.)
This also works for mask reuse (which is where I got the idea from originally). (This article says "The new coronavirus is sensitive to heat. It can effectively inactivate the new coronavirus by heating for 30 minutes at 56 degrees Celsius." but does not cite a source for this. I wasn't able to find a study for the COVID-19 virus, but did find the following data for SARS: https://link.springer.com/article/10.1007/s00430-004-0219-0/tables/1)
The second time, I meant "increase the oven temperature or time enough to thoroughly heat the food including the middle/inside of the meals to 70C for 30 minutes." So the idea is that if you're not sure only the outside of the meals may be contaminated, you need to increase the oven temperature/time but I can't tell you by how much because that depends on the specific food, so you'll have to figure that out yourself or use a meat thermometer.
I just thought of this idea: carry a box of disinfectant wipes everywhere, and whenever you want to touch a surface that's touched by many people (handrail, door handle, elevator button, touchscreen kiosk...) give it a quick wipe-down first. That protects you, helps protect other people, shows them how to do the same, and also disinfects your hands many times a day. Any problems with this?
Figure out now who will take care of you if you get extremely sick and who you will take care of if they get extremely sick.
Making these expectations explicit could pay off. Different people have different norms around what level of care vs avoidance should happen when someone is sick. If you became extremely sick, you might lose the coherence necessary to arrange help for yourself.
Advice: have disposable wipes by the front door and use them to wipe your smartphone and then manipulate your handwashing sink each time you arrive home.
Model: You are touching your smartphone while out, and to whatever extent possible you want surfaces inside your home to be controlled. CDC recommends disinfecting touchscreens but many people don't because disinfectant can damage special coatings. One can bite the bullet or consider adding on another screen cover.
I have been disinfecting my smartphone and glasses with disinfectant wipes, and have had no problems with coatings so far. I haven't used them on my computer screen; I know the antireflective coating on the macbook screens can be sensitive.
My disinfectant wipes are neither alcohol nor bleach, but quaternary ammonium (with a list of ingredient names all having the form "...yl ammonium chloride".) My sense is that this seems to be typical of generic "disinfecting wipes".
I started to self-quarantine from 25 January, reasons: uncertainty in mortality and the need of a test run. At that moment the situation with mortality was not as clear as it is now. I still don't exclude higher mortality level (than in the table) as for many patients the disease is around one month long and this data is not accumulated yet. I also more than 40 years old and have hypertension which is a risk factor.
My observations about self-isolation: I eat more, and as a result my stockpile is going quicker than I expected. And also I gained weight. Also, sometimes I feel my self like in a prison and want to go out despite any risks. After I go out eventually, I felt more tired as possibly first sign of atrophy of muscles. All this means that long term self-isolation has its own risks, mostly cardio-vascular and mental state.
This test-run of self-quarantine helped me to perfect protocols of cleaning things after I went out and of proper wearing masks. Not all masks fit equally well, and it depends on the shape of the face.
What are the benefits of "don't go outside at all" vs "don't take walks, if you make sure to never be within 10 feet of people?" (I suppose how achievable this is depends on where you live. I guess I couldn't do it in NYC, but could do it in Berkeley easily)
I'm curious about this too. My partner and I love to go out on night walks, around 12-3am. Our apartment door opens directly to an open to the outside hallway and we very rarely encounter others at this time. Therefore I assume that even under a self quarantine situation, it should be fine to continue these walks?
I live in an apartment complex in a large city, so I am likely to meet people near elevator. There are also a lot of people on the streets during the day and to reach nearest park I need to walk 15 minutes by streets. Maybe I can walk outside at 3 AM.
It wonder if this would be a good use case for normal face masks. Presumably they decrease the distance the virus would travel if you coughed (and also warn other people to keep their distance). Unfortunately I'm having trouble finding any research on this (everyone seems interested in masks to protect the wearer, or long term use, not short term use to prevent infecting others).
I used to think CDC recommendations were not great but better than nothing. I've changed my mind after seeing them say coronavirus can't survive on surfaces for very long, so I'm retracting this comment.
I had heard the 6 feet rule (which roughly matches my "how far I think people can usually spit"), but didn't know where I had heard it from, and scaled it up a bit for additional margin of error based on my intuitive knowledge of cough physics.
I wonder if ensuring one has an exercise plan (or perhaps some equipment -- could be DIY type equipment) should not also be on the list of items to "stockpile" if one is self-isolating or even under quarantine.
I never really thought about that before you mentioned it, but I have an orbital machine in my workshop/garage so take that from granted.
I think you should try to get antibiotics, antivirals, and/or antifungals for secondary infections in case hospitals are full and you need to treat yourself. According to this study, “When populations with low immune function, such as older people, diabetics, people with HIV infection, people with long-term use of immunosuppressive agents, and pregnant women, are infected with 2019-nCoV, prompt administration of antibiotics to prevent infection and strengthening of immune support treatment might reduce complications and mortality.” About what treatment people in Wuhan were given, the study says:
Most patients were given antibiotic treatment (table 2); 25 (25%) patients were treated with a single antibiotic and 45 (45%) patients were given combination therapy. The antibiotics used generally covered common pathogens and some atypical pathogens; when secondary bacterial infection occurred, medication was administered according to the results of bacterial culture and drug sensitivity. The antibiotics used were cephalosporins, quinolones, carbapenems, tigecycline against methicillin-resistant Staphylococcus aureus, linezolid, and antifungal drugs. The duration of antibiotic treatment was 3–17 days (median 5 days [IQR 3–7]). 19 (19%) patients were also treated with methylprednisolone sodium succinate, methylprednisolone, and dexamethasone for 3–15 days (median 5 [3–7]).
I think this sort of treatment might be one of the biggest factors in lower mortality for people with access to hospitals, so I suspect that getting your hands on some prescription antibiotics beforehand could be quite valuable. Some of the pharmacies that Wei Dai recommends here [LW(p) · GW(p)] could be good bets, though I'm still currently trying to figure out what the best way is to do this—if anyone has any ideas let me know.
This not-particularly-reliable source says "So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality".
According to the CDC the coronavirus is thought to spread similarly to how the common cold spreads: person-to-person spread, and contact with infected surfaces or objects. The gym is a place where you'll be in close proximity with other people, and where you'll be touching surfaces that many other people have touched, and thus is a place where the risk of getting infected is high.
On top of that, the downside to working out at home seems quite low. There is so much that you can do without gym equipment (burpees are awesome if you don't mind the intensity), and there are large diminishing returns to exercising more and to exercising more efficiently. Plus, changing up your routine is good for both effectiveness and for fun.
Check the active ingredient of your hand sanitizer. You may have one that contains benzalkonium chloride, which does not work against at least one type of coronavirus. (This turns out to be the case for one of the hand sanitizers I've been using.) Get one that has "greater than 60% ethanol or 70% isopropanol" instead, as recommended by CDC.
ETA: I didn't bother to check this until today, because why would the FDA approve or fail to pull from the market, hand sanitizers that don't work against an important group of viruses? And why hasn't there been any articles in the MSM about this?
That study is on inanimate surfaces, and benzalkonium chloride is the main ingredient of Clorox, Lysol and other disinfectant wipes. So it might be a good idea to switch to isopropanol wipes for surfaces too.
Do cardio exercise—at home or jogging (not gym for transmissibility reasons, as mentioned in this other answer. [LW(p) · GW(p)])
Why cardio, and why now? My thinking is: a primary reason for COVID hospitalization is not being able to get enough oxygen (cf this answer [LW(p) · GW(p)]), and its primary treatment is with concentrated oxygen or (in more severe cases) mechanical ventilation, and the nightmare scenario [LW(p) · GW(p)] is not having concentrated oxygen equipment etc. for the number of people who need it (I guess some appreciable fraction of the 20% of cases that require hospitalization). So it seems highly plausible to me that starting from a state of good cardiovascular health (hence high blood volume, high lung capacity, efficient heart pumping, etc.) would give the body some extra slack such that COVID can gunk up the lungs slightly more and for slightly longer, before you suffocate and die. This speculation is also compatible with the COVID death rates being apparently higher in populations that I would guess have generally worse cardiovascular health (in terms of age, pre-existing conditions, etc.). Again, to be clear, I have no proof of a causal connection, or even proof of correlation, just a vague suggestion and plausible-seeming mechanism (to my non-medically-knowledgeable mind).
By the way, my experience is that, after a long exercise hiatus, there's clear improvement in "not feeling out of breath" over the course of even the first couple weeks of cardio exercise, so it's not too late to get started. :)
I'll excerpt my On Masks Section as I suspect the reasoning contained within will be the most appropriate and interesting to this thread. But there is good stuff throughout, I've built things for lay readability, and am not a technical expert, I would appreciate thoughts and advice. I don't have variables for mask exposure, but I think my reasoning is solid and useful. You can tweet me @qastokes
About N95 Masks
All non-N95 face masks, such as medical masks, (of the dental kind), are relatively useless for self-protection, as they lack a seal. Please donate your excess to medical facilities. These are very useful for containing the spreading of all illness, those who are sick and coughing, regardless of disease, should find and wear these type masks. Containing spread is far more effective than reducing exposure for managing the risks.
Please understand N95 isn't prevention, it's odds increase. When properly fitted and used it reduces exposure, but technically it's only 95% efficient.
An N95 might keep a doctor with constant exposure alive, but won't help Joe who's out shopping much. Wearing a mask could theoretically increase your risk if used wrong, by being a capture of virus that moves along with you and extends your exposure time. It is not generally helpful, compared with handwashing and effective prevention protocols.
It is true there is benefit to be had by using a mask. But it is only significant if you are competent in following the use protocol. It is better by far to learn & to carefully follow all the other higher impact protocols, especially handwashing. By far the greater benefit, for you individually considering your total exposure risk across time regarding the disease and it's spread, around you to managing your personal exposure will be for those managing the disease directly to have the best protection they can. Hence my advice to donate extra masks to those at highest risk.
Think about this along the lines of "the more the disease spreads, the greater your total exposure risk, regardless of managing your personal exposure risks."
Note: For really significant improvement in your exposure chances, I & wearing a mask effectively, you will need to carefully follow the behavior protocol for a disposable full body exposure management system. A protocol which includes gloves, a hooded tyvek particulate suit, and goggles, along with the mask, this is only really applicable in an extremely exposing environment. Additionally, a P100 would be the optimal mask of choice for this situation and protocol.
The biggest risk management benefit comes from one complete set of masks and a full body exposure management system for every one of your loved ones. This allows you the freedom to make one situation optimizing decision in a worst case scenario.
This would look like:
The family is out of food. Healthcare is overburdened to the point the death rate has matched the critical cases rate. You must move with high risk of high exposure.
Alternately, with planning these suits can also be burned one use at a time in a clean room caring for a loved one, allowing for several days of constant and very direct care with low gain viral load & exposure risk for those still without symptoms or as yet uninfected.
Note for completeness: of all the routine contexts to wear a mask, high droplet spray environments are the ones the mask will help in the most, especially if you sanitize your clothes afterwords. I would strongly consider wearing one in a crowded subway, if there is a known outbreak in your city. This would only significantly help if you wear the mask correctly, sanitize clothes, & don't touch your face and are meticulous about hand washing.
Takeaway - here are the 5 methods in the first paper:
Autoclave (similar to pressure cooker)
10-minute submersion in 70% ethanol
10-minute submersion in 100% isopropanol
10-minute submersion in 0.5% bleach solution
All methods of decontamination damaged the masks. It seems that alcohol and bleach significantly damaged overall filter quality (ratio 0.30 to original), but rice cooker and autoclave relatively preserved it (0.98 to original). I can't see the results for the IPA method on their chart but I expect it to be similar to the other chemical methods.
The other paper on sanitizing efficiency also looked at UVC and UVA light. It found "Bleach, UVC, an autoclave, and a <rice cooker> provide better biocidal efficacy than ethanol and UVA".
My conclusion in this is that rice cookers, pressure cookers and especially the instant pot - which offer comparable performance to commercial autoclaves can be used in an emergency situation to sterilize masks for a few uses. Be very careful about the way you don and doff the mask and handle them generally.
The CDC recommends using "...a cleanable face shield (preferred) or a surgical mask over an N95 respirator..." for extended use or reuse. This may make it more difficult to breathe, but perhaps worth trying. Surgical masks are also not so available these days, but maybe something like a bandana or other covering would also help protect the mask.
A lot of stores are using touchscreens now meaning you're touching the same spot as literally the entire flow of customers before you and no one ever cleans those. But you can use a touch screen stylus. I got one with a cap so that I can carry it more easily without contaminating other surfaces.
As Eliezer reminded us, most people sitting alone in a room will quickly get out if it starts filling up with smoke. But if two other people in the room seem unperturbed, almost everyone will stay put. That is the result of a famous experiment from the 1960s and its replications — people will sit and nervously look around at their peers for 20 minutes even as thick smoke starts obscuring their vision.
The goal of this post is twofold. First, if you’re the sort of person who will keep sitting in a smoke filled room until someone else gets up, I’m here to be that someone for you.
If results of the experiment are real, I think we can expect 1) people to hesitate to take the coronavirus seriously, 2) people to take it more seriously if they know that you are taking it seriously. We want people to take it seriously, and so advertising that you take it seriously — as Jacobian did — seems like a good thing to do.
This could mean texting your family and friends, or posting on social media (in such a way that doesn't incite panic).
Consider that some people may be higher yield targets of your advertising than others. Someone who is capable of changing their mind, has the option of working from home and who lives in a densely populated area is an example of a high yield target.
Nutrition seems to have some influence on the effects of viruses.
Make sure you're not deficient in selenium or vitamin E. One brazil nut per day is enough to give you more than the RDA for selenium.
Note that selenium deficiency is relatively common in central China. The average selenium level in Hubei isn't low, but it has a large range of levels, and the person with the lowest level in that study was from Hubei.
There are also some reports that vitamin Cmight be valuable. But there's some concern that large doses of vitamin C are risky if you have high iron levels (usually measured by a blood test for ferritin).
I expect that nutrition has a pretty low probability of helping, but it also has a pretty low cost.
It is recommended to avoid touching your eyes, nose, and mouth. People tend to inadvertently touch their eyes, nose, and mouth many times per hour. If you think you can substantially reduce the number of times you touch your face by training yourself to avoid doing it, in some low-effort way, go for it. If it takes time to become good at not touching one's face, it may be worthwhile to start training at it now even if where you live is currently coronavirus-free.
: The CDC (Centers for Disease Control and Prevention) writes:
The best way to prevent illness is to avoid being exposed to this virus. However, as a reminder, CDC always recommends everyday preventive actions to help prevent the spread of respiratory diseases, including:
Avoid touching your eyes, nose, and mouth.
: The video by the CDC that Davidmanheim linked [LW(p) · GW(p)] to claimed: "Studies have shown that people touch their eyes, nose, and mouth about 25 times every hour without even realizing it!"
I've been trying to reduce my face touching for more than 6 months now as part of a project to get less colds and only managed to really get there in the last 2 months.
I also work in a lab with gloves where I have to take care what I touch a lot, which is daily training. Still I have found it frustratingly hard not to do it, so I don't know if many people can quickly train themselves.
Things that help me:
have paper tissues around and use only them to rub nose/eyes
scratch face with inside of clothes (less obtrusive than it sounds)
wear gloves in public (I guess that works because my hands feel different, like in the lab)
watch out for other people in public doing it wrong (keeps it on my mind)
As a classical guitarist I naturally keep the nails on my RH long, but I read advice to cut them because they are harder to keep clean underneath and carry disease longer, and I'll probably do that. I'll probably shave off my beard too for similar reasons (and to stop me touching my beard+face as much.
I discovered a way to practice this recently, I was drawing with vine charcoal, which is dark and very dusty, and I got dark dust all over my hands. Then I touched my face inadvertantly and I could see in the mirror where I had touched.
Later I tried to wash it off and was able to wash it off only when I really focused on how I moved my hands in order to scrub any area. The entire thing felt like good practice with hand higene. So to practice this, improvise a colored dust - charcoal, ash etc, and practice washing hands and not touching face.
If you have long(-ish) hair, wear something that will keep your hair off your face.
Rationale: I'm training myself not to touch my face, and more often than not, I want to do so to get my hair out of the way.
Also, I touch my hair very often (to fix its position) but I wash my hair much less than I wash my hands, so if my hair regularly touches my face, it's plausible that I'm at greater risk of catching the virus through my hair rather than through my hands.
It seems like you should never touch buttons outside your house with your fingers. Carrying around an object like a pen that's wrapped in copper tape to push buttons allows you to use buttons without touching them with your fingers.
Advice: Humidifiers. We need them now, and everywhere that people gather in temperate climates. There's a reason why the common cold, influenza, and indeed SARS all die out as summer approaches in seasonal climates--relative humidity over 40% is the best method for controlling airborne viruses.
"The present study allowed us to assess viral infectivity under various levels of relative humidity and showed that one hour after coughing, ∼5 times more virus remains infectious at 7–23% relative humidity (RH) than at ≥43% RH." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583861/
What's your model for how useful this is? COVID spreads in public places, and it's mostly spreading via droplets on surfaces. Changing indoor humidity seems like it would only have a very minor impact, if any.
This makes little sense to me. Viruses are different, spread differently, and will react differently to environmental changes.
And I do not understand why checking for fever routinely is less tractable as a routine habit than, say, using humidifers. And distracting from exclusively promoting handwashing seems like a huge net negative, given that we still haven't gotten people to change their habits.
When it's hard or impossible to avoid touching one's face or staying 2 meters away from others, wear a combination of ski mask, safety or medical goggles, and surgical mask. This would prevent touching one's face and having droplets land on one's face.
Track your sleep quality and make sure you are getting enough. There are smartphone apps (like Sleep Cycle) that can do this. Your immune system is one of the first things to go with even mild sleep deprivation, which makes you more susceptible to infection. You may have to adjust the timing or dose of your caffeine intake. You might also consider melatonin (see Scott Alexander's guide for optimal timing and dose).
Here's a guesstimate model I made to try and figure out when hospitals will become overwhelmed. Lots of model uncertainty here that I'd appreciate advice on, but the current prediction is that there will be a hospital bed for you if you get infected in the bay area within the next 6 days (95% confidence within the model: actual confidence is much lower).
If hospitals are overwhelmed, it's valuable to have a component of the hospital treatment plan for pneumonia on-hand to treat either yourself or others who have it especially bad. One of these is oxygen concentrators, which are not sold out yet and are ~$400 on Amazon. This doesn't deal with especially severe cases, but for cases which fall in the "shortness of breath, low blood oxygen" class without further medical complications, it'd probably be useful if you can't or don't want to go to a hospital due to overload. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected mentions oxygen treatment as the first thing to do for low blood oxygen levels.
I bought this one online (the cheapest device I could find advertised as capable of pulse flow, which may be important [LW(p) · GW(p)]), and it's going to take about a month to arrive. I suspect this device is manufactured outside the US--if people in the US are having a hard time getting ahold of them quickly because it takes a month to ship them from overseas, I can donate mine.
Due to exponential growth, much of the expected impact of COVID-19 is in April/May/June. I feel pretty comfortable prepping now and sending a market signal that we should ramp up the production of prepping goods.
Good idea. I purchased an oxygen concentrator. However, you might wish to use the device on a low pressure setting (or use it in "pulse" mode instead of "continuous" mode) because I'm hearing some rumors that oxygen therapy can be counterproductive:
Professor Liu Liang also said that if the mucus components are not resolved in the treatment, the use of oxygen alone may not achieve the purpose of treatment, and sometimes even counter-productive, pushing the mucus deeper and wider, aggravating the patient's hypoxia.
Do your shopping in bulk in order to minimize the time you spend public. Or do your shopping online and have it delivered.
The more time you spend in public, the higher the risk you get infected. Shopping in bulk minimizes the time you spend in public, and thus lowers the risk that you get infected. For example, stocking up at Sam's Club versus going to the supermarket twice a week.
I suspect that for most people, the downside of shopping in bulk or shopping online is going to be very minimal. In many cases I suspect that it is optimal even without the coronavirus being a thing.
Also consider the experimental benefit. If you don't have much experience with shopping in bulk or online, trying it out for a few weeks will give you a better sense of what your true preferences are.
Advice: now may be a good time to learn to meditate. Deaths from coronavirus are due mostly to breathing problems from pneumonia, which is the main explanation for why older people are more likely to die. There is evidence that meditation is good for pneumonia specifically http://www.annfammed.org/content/10/4/337.full and lowers oxygen consumption generally https://journals.sagepub.com/doi/full/10.1177/2156587213492770. I didn't read the studies carefully to see how trustworthy they are, but this conforms well with my understanding and limited experience of meditation. Meditation is also known to be good for mitigating stress, which will obviously be beneficial in the coming months.
There's a theory that BCG vaccine (TB) helps strengthen you against corona, I'd recommend getting it if you haven't, or especially for your older relatives (given that the cost/side effects is well-understood and near-zero, whereas the benefits based on the below could be serious):
Very speculative: there are different strains of BCG, and allegedly the old (Soviet/Japan/Brazil) type/types is better. This could theoretically explain the different corona case loads between West/East Germany and between Japan + Thailand + Taiwan vs China + Iran (different vaccine strains).
Here are images showing differing corona case loads between East/West Germany (East uses/used the Soviet vaccine), supposedly the population density does not explain this (though note travel patterns, testing rates, etc. are probably all different):
I'd recommend getting it if you haven't, or especially for your older relatives (given that the cost/side effects is well-understood and near-zero, whereas the benefits based on the below could be serious):
I would recommend doing more research before making recommendations like the above. tb-throwaway.
@leggi, thanks, I think the key thing here is that BCG isn't used to protect you against TB here, but broadly boost your immune system. I found a bunch of papers on this (admittedly, many about youth, but also some on the elderly getting BCG):
The efficacy of Bacillus Calmette-Guerin vaccinations for the prevention of acute upper respiratory tract infection in the elderly.
AIM: to study the efficacy of BCG vaccinations, once a month for 3 consecutive months, in elderly on the prevention of acute upper respiratory tract infection (AURTI), interferon - gamma (IFN-γ) and interleukin (IL)-10 level in the BCG and placebo group and their comparison in the period of the study.
CONCLUSION: BCG vaccinations in elderly, once a month for 3 consecutive months, significantly prevent the AURTI and can increase the IFN-γ level as Th1 response and IL-10 as Treg response in the period of the study.
BCG has also been used for decades to boost immune system in fight against gallbladder cancer, as immunotherapy:
a) we know the safety profile of BCG, and people can evaluate if they're at risk of any adverse reactions (largely minimal) from getting it, and
b) it does seem to boost immune system, broadly and against the upper tract respiratory infections in the elderly (in addition to many other studied benefits for youth)
It seems that the negative costs of getting it (refreshed) are nearly 0, whereas the benefits are >0 and potentially great. On this basis, the recommendation makes sense, IMO (for anyone who isn't at a risk of some complication from BCG, based on the safety profile).
The top set of links aren't working but the study to URTI rates is very interesting.
Firstly for the use of 3 doses a month apart - one dose is the standard for BCG.
I had a BCG at about 7 years old due to contact with a diagnosed TB case. Age 11 I had a positive reaction to the tuberculin skin test (Mantoux) but still got given a second dose, even though I told the school nurse it wasn't recommended - cocky little sh!t even back then and I'm sure she stamped me twice as punishment... Now thinking good for me!
Also, that there was a strong immune response in elderly subjects who tend to be considered as having a weaker immune system overall.
Testing at 6 months from 1st dose:
There were significant increase of IFN-γ and IL-10 levels in the BCG group compared to the placebo group. There were insignificant increase of IFN-γ and IL-10 levels in the pre- and post-BCG group
Memory B cells are present "for decades" so for those that have received the BCG this effect should apply.
For bladder cancer:
BCG is put right into the bladder through a catheter.
A different mode of action than a standard BCG vaccination, not so much boosting the immune system but drawing attention to the cancer cells in a localised manner.
Regarding the "cytokine storm" seen in severe patients - would previous vaccination make this worse? Musings, no idea what reality will be. But countries with vaccination programs v. those without should provide some interesting data.
Did you come across any information about any specific antibodies have been associated with COVID19?
This is likely to:
(a) last for months, not weeks - so don’t bother stockpiling, you can’t store enough to outlast it.
(b) affect 60-80% of an unimmunised population (all of us) with a doubling time in confirmed cases of 2-3 days initially.
(c) produce minimal symptoms in the majority of cases (by minimal I mean nothing you cannot handle with over the counter analgesics, plenty of rest and your favourite hot drinks) just like the currently endemic corona viruses.
(d) be moderately lethal for older people, especially smokers & those with existing respiratory / cardiovascular conditions.
(e) become endemic (annual, like flu & colds) unless we get a vaccine.
Solution? Keep calm & carry on, hoping your government is transparent and has your best interests at heart.
If it's more important for you to avoid contracting the virus right now than it is for others, schedule any doctor's appointments you are going to for first thing in the morning. Reasoning: seems like hospital contamination should rise throughout the day as more and more people pass through and then drop during nightly cleanings. Similarly for any needed outings, do it in the morning, because though the virus can survive for days on surfaces, presumably it's safer to touch just after an 8 hour break from people than just after a 2 minute break from people. No idea of effect size but I don't see why these mechanisms would be wrong.
While I suspect the option for non-cash payment will remain it is possible that in some cases having cash on hand might be needed. If so, you probably don't want to go to the bank/ATM and get something that may have passed though a bunch unknown hands.
I am thinking that suggests two things.
1) Make an assessment of your potential cash needs and get them sooner rather than later. Two reasons here. Lowers the chances of being contaminated. You can then set it aside as well as do some sterilization and let sit (to dry?).
2) You might not want to get large bills but more smaller denomination. That way you can simply leave the change and not worry about accepting anything back.
Again, might have been suggested but a quick search on cash and currency didn't get any hit.
Advice: drink a mouthful of water every 15 minutes. This is speculative (facebook post from a friend of a friend). The rationale is that if you have virus particles in your mouth, rinsing them into your stomach (where the stomach acid kills them) will prevent them from getting into your respiratory system. [edit: retracted, seems to be downstream from a fake news article. Drinking water is still good, but looks like this pathway is not realistic]
Most advice here seems to be of the form "here's a thing that has a benefit" or "here's a thing that has a benefit, and the cost is low". But without an estimate of the relative magnitudes of the costs and benefits, it's hard to know whether taking the advice is worth it. I wish that more advice included this type of cost-benefit analysis, perhaps with a parameter of how bad things are so that one could say, for example, "it's worth it to do this thing if you think X proportion of your city will eventually be infected".
There is probably an optimal humidity level, but looking at data from other viruses is producing very mixed results about what that level might be. Does anyone else want to dig through some more papers? This might also be a case where better data will be available in a few weeks.
This study found that environmental humidity was positively correlated with nCoV rate of spread. This paper measured surface persistence of SARS, and found that it persisted less at moderate relative humidity (50%) than at low (20%) or high (80%) humidity. This paper tested MERS-CoV, and found that increasing humidity from 40% to 80% decreased persistence on steel, but increased persistence on plastic.
So the SARS virus exhibits, at least in the lab, Antibody Dependent Enhancement which is what can allow a virus to affect you multiple times. Here's a paper on it. Since COVID-19 is related to SARS it seems plausible the reports of reinfection are real. I don't understand this enough to say much more about it.
Is this a good place to put questions that I want answered?
Is there some reliable source on the triggers for quarantining one's self? Both immediate triggers (when x happens, I will not leave the house again until y happens), and warning signs (when z happens, I'm going to leave the city, in preparation for quarantine).
The US currently has 15 confirmed COVID-19 infections but what we want to know is the number of infected at large.
Let’s try to estimate this number.
Around 3M Chinese visit the US annually not counting other foreigners or American citizens who travel to China and return.
Before US Borders were closed to China travelers the virus was already prevalent for at least ~14 days during which infected people traveled freely.
That implies at least 115,068 visitors who had recently been to China entered the US from Jan 9th — Jan 23rd. To guess how many may have been infected I noted that China’s initial quarantine area encompasses 60M people which is 1/23rd of China’s population.
Therefore ~5,000 suspected persons arrived in the US from affected areas. Assuming the infection rate was around 0.5%, we can guess there were around 25 infected people at large by January 23rd. But which 25 of the 5,000??
Note: some infected may continue to come in from China but only if they are US permanent residents or citizens (and they are forcibly quarantined in military installations). The US does not currently limit arrivals from Thailand or Singapore however, as opposed to Israel, which was the first to announce such limits today.
In an assertive scenario the US government would track down all 5,000 suspected infections above as well as anybody they interacted with and put them all in quarantine.
I have heard no reports in that vein and believe it’s likely not the case. On the other hand, there have been reports of dangerous mistakes, such as incorrectly removing an infected person from a hospital in San Diego.
Even worse, we can’t tell how many people are now infected but don’t have a reason to suspect they have it. They may have been around an asymptomatic infected person who came from Wuhan or touched a contaminated surface.
If in fact COVID-19’s “asymptomatic R0” is over 1, a single infected person would start an epidemic cascade. I think it is highly probably this is happening now but that we are in the early stages of the exponential curve and therefore the problem is invisible.
Furthermore, because most cases are mild, infected persons may be misdiagnosed or not seek treatment. The virus may go through 5–10 growth cycles before we realize a city outbreak is underway.
Once it’s clear there is an outbreak in say Columbus, OH, it’s hard to say how many people the local infected persons have already spread the disease to and it will be hard to find them all.
My answer is an attempt to do something similar. Note that I think strictly speaking you can do without self-quarantining: my impression is that if you go outside and aren't within 2 metres of other people, you don't have a serious risk of aerosol infection, and if you can manage to avoid touching stuff (or wear gloves, refrain from touching your face, and throw them out upon getting inside) then you avoid contact transmission. So going on hikes seems fine to me, and means (a) you don't go stir-crazy (b) you get some exercise.
I actually weakly recommend against that for the immediate future – there's some features I plan to implement that'll give related questions more visibility (I might prioritize getting them done soon), but right now they don't work that well in practice.
I chatted with Ray, I think that related questions is a good fit for this. People will primarily find the related questions via this post at the current time, which actually makes it pretty good for spamming with questions. Eli, I'd be pro you submitting a related question (it goes where the answer box is).
I've been struggling with the question of whether I should leave the SF area to go to my parent''s house in the suburbs of Virginia, and I expect other people are facing similar conundrums. I'll share my thoughts on it below and would welcome any advice especially anything that I have not considered.
Background: My parents (both 50 - 60) live in a detached house in the Virginia suburbs. It's very large with 3 floors and many bedrooms and has an inlaw unit. I currently live with 3 roommates, one of whom is my partner, in a tiny apartment in downtown San Francisco. 2 of those roommates have jobs in SF, another is unemployed but unconcerned with the virus, and I'm unemployed, living off saved income and very concerned. Currently we are all asymptomatic, but my partner did fly to Canada last week and has been isolating with no symptoms.
I'm considering whether to take my partner and fly to Virginia to be in our parent's house, likely early next week. Thoughts
I expect the transmissibility of the virus to be much lower in the suburbs since they are so much more isolated - people driving around in private cars, each with large lots of land. The city is a sea of people. Pro-leaving, for my own safety.
Isolation will be more pleasant at my parents house since the house is much larger. If all four of my roommates were couped up together, which is the ideal case, it would be pretty close quarters for a long time. We have one tiny kitchen and tiny living room. Pro-leaving.
I expect we will be more successful at actually isolating in the suburbs - for one thing my partner will be forced to work remote, for another, stores will be much further away, currently even knowing we should isolate we are continually shopping for groceries, prep supplies, etc.
The SF area seems to have some sustained community transmission. Pro-leaving for my safety, anti-leaving for my parent's safety.
I expect the virus to be more dangerous to my parent's health than to me due to their age. This is anti-leaving if I could spread it to them, but pro-leaving if my presence there would encourage them to take it more seriously.
There seems to be a part of my brain that believes this is all an overreaction, although I think there is great cause for concern. I think that may just be normalcy bias talking.
I'm unsure if isolation is a viable long term strategy but isolating for at least a few months gives time for more information and potential treatments. It is unclear when the "best" time to contract the virus would be, outcome wise.
The virus is spreading here more and more, and if I am going to go, I had better go soon as a quarantine could come down or my chance of infecting my parents will go up
I am not working right now and my partner would be able to work remote so income/etc doesn't really factor into it for the near-term.
I think it shakes out that leaving would be good for my safety and my partner's safety but bad for the safety of our parents if we transmit it to them. But it's possible we could even isolate there in the in-law unit.
Something you seem to have not thought of is that if you stay in SF, you'll probably feel more anxious than if you were staying with your parents. Both due to the risk of getting the virus, and due to questioning whether you should get out of SF. I know that I personally would have those anxieties.
But it's possible we could even isolate there in the in-law unit.
I thought this was the pretty clear cut answer before you wrote it. Totally endorse. Wear masks on the flight if possible. Ask your parents to stock up or start sending prep packages there (Amazon, Costco delivers)
This doesn't seem to be advised unless you have professionally fitted N95 masks. Surgical masks and nominally fitted serious masks do a decent job of preventing you from transmitting the virus, but little to protect you. And anecdotally, wearing a mask may cause you to touch your face and mask a lot more, which is on the wrong side of the trade-off.
I think it's actually not hard to fit N95 masks reasonably well at home. You can google for the fitting guidelines. The most important thing is being aware that you need to pay attention to fit.
A good fit is important, but a completely perfect fit is not required to get substantial protection.
(If you have facial hair, as I do, you will face significant challenges. Otherwise I think good fit is straightforward to achieve. I think it's easier to achieve with reusable masks than disposable paper ones, but then you have to worry about disinfecting the mask between uses. I have a question below related to this.)
Thank you for your input. I would like to go but I want to bring my partner with me and she is against it, I think because it feels extreme. My brother thinks it would be dangerous to my parents to travel to them, my father thinks it is inevitable to get the virus everywhere so it would be useless to travel to them. It feels like each is uncomfortable with taking action and justifying that feeling with a different faux-logical screen.
Sigh. I'd like to go and I'll work on convincing my partner. We went out for dinner today which strengthens my suspicion that as long as we remain here we won't ever really isolate. My parents have said that I am welcome to come and quarantine in the in-law unit. Thanks for your advice.
EDIT: My partner started to cough, which increased my estimation that we might be incubating it. Still very low chance but it made bringing it home to my parents a more real possibility. I decided to stay and risk it in the city
In scope: information about half-facepiece reusable respirators. Out of scope: whether you should wear a mask, etc.
Reasons to prefer a reusable respirator over a disposable one: they're (i) more comfortable and (ii) prosocial, preserving disposable masks for medical personnel.
You need to buy two components: the mask and filters.
The mask. The wirecutter recommends 3M's 6500 series. I have the next model up, from the 7500 series. The 7500 comes in three sizes, small (7501), medium (7502) and large (7503). I think the idea of the sizing is: medium fits most, but there are also small and large (evidence: some stores only stock mediums). If you are familiar with the size of my head, I'm a medium. If outside the US, say in Australia, 3M masks might be hard to find, so you might try other brands like Sundstrom.
The filters. These come in a vast number of options and it's all quite confusing. A good source of information is this 3M guide. For viruses, we're interested in particulate filtration. Summarizing page 3 of the 3M guide, a filter is described by a minimum efficiency (95%; 99%; or 99.97% \approx 100%) and a letter that describes whether the filter efficiency degrades in the presence of oil-based aerosols (N, R, P), which is not relevant for non-industrial use. You combine a letter with the minimum efficiency, e.g., N95 = minimum efficiency 95%, not suitable for use in the presence of oil-based aerosols, or P100 = minimum efficiency 99.97%, will not degrade in the presence of oil-based aerosols. Some brands will use European nomenclature: P2 = P95, P3 = P100.
A filter with higher minimum efficiency will be harder to breathe through. That said, I personally find it quite comfortable to breathe through a P100 filter (e.g., I find it easier to breathe through a respirator with a P100 filter than breathing through an N95 disposable mask), so I would recommend using a 99.97% efficiency filter. Maybe the trade-off between filter quality and how easy it is to breathe will be different for others.
Filters are sold in pairs. In terms of specific 3M P100 filter recommendations, the 2291 is the best (it's more expensive but designed to be easier to breathe through), then the 2091 is next best, and the 2296, 2297, 2096, and 2097 are fine too -- they have an extra layer of carbon filter for relief against nuisance levels of certain gases, which you don't need for virus filtration (but if you're walking around a busy city with lots of traffic, the 2297 or 2097 might be preferable). All these are fine though so get whatever is available. All of them are compatible with 3M 6500 or 7500 series masks.
I'm unsure how long a particulate filter lasts. I think the answer might be be months if you're not working in dusty environments. They become more efficient over time but harder to breath through. This 3M guide doesn't give a timeframe to expiry, it just says to replace them when they become dirty or difficult to breathe through.
Does the surface of a filter become contaminated? I don't know. Presumably? Maybe don't touch it. If you get a Sundstrom respirator, the filter is entirely encased in plastic, so you could regularly disenfect the parts of the mask that you can touch.
In the case of a shortage, there are a number of combination cartridges that filter against various gases as well as particles. For example, all those on page 18 of the first 3M guide. These will work for particulate filtration, you're just also paying for the gas filtration (in money, heaviness, and possibly in that it is more difficult to breathe through them).
I'm wondering how well viruses stick to/survive on clothing. In trying to avoid touching my face, I've occasionally resorted to using sleeves of my hoodie instead – which I also use to touch surfaces like door knobs or light switches. Should I use the elbow for those instead?
Your clothing will contain infectious virus that can be passed on for up to a week or more. This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average - everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth. James Robb, MD FCAP
A question (using the comment feature because I do not yet know what "ask related question" actually does): Is it advisable to use reusable (rather than disposable) filter masks, if available? (They are obviously much more expensive, but they also have much higher availability right now in many cases; and people who attend Burning Man, or have hobbies involving noxious fumes, may already have them.)
If so, what are the right precautions to take? Obviously throwing away a disposable mask eliminates all possibility that it will later create a contamination hazard when reused. But reusable masks generally have nonporous surfaces that can be easily cleaned with a disinfecting wipe. (It has to be one that doesn't create noxious fumes, obviously! This eliminates bleach for sure; alcohol may be okay if you wait long enough for it to evaporate. I'm not sure how quaternary ammonia compounds are on this metric, but my wipes at least do not seem to smell noxious.)
My plan is to use a reusable p100 mask, with copper tape on the structural components, hopefully forming a barrier between the external filters/valves and the internal surfaces, and then to wash my hands before / after wearing it. No idea whether this will be any good, but it seemed more workable / less potentially blameworthy than acquiring disposable masks in a shortage.
Related question: at what point should university students begin partial-quarantine measures such as not going to large classes and not going to cafeterias?
I'm concerned about the cafeteria things especially, because it seems like a pretty potent vector for transmission and also relatively avoidable by just buying/preparing your own food. At the minimum, I suspect that doing things like bringing your own utensils/plates that you've disinfected to be a reasonable precaution, although all the food is sort of sitting out so I'm not sure if that's even a thing that will help. I live reasonably close to my university, so I could also just go home at some point.
For reference, it would roughly cost ~$5-20 a day to avoid the cafeteria, depending on type of food created/purchased.
With a little research I think you can probably save money by avoiding the cafeteria. Budget Bytes has a lot of meal ideas for a few dollars a meal that can be cooking in advance and in bulk.
Both cafeterias and classrooms seem like places that'd have some of the highest risks of infections, due to being in close proximity to others but moreso because you're touching surfaces that others have touched. It seems like a good idea to me to avoid cafeterias because it wouldn't be too difficult to find a different place to eat. Perhaps your car. Or perhaps at tables that aren't used as frequently as the cafeteria.
But the downside of not going to class seems much larger. Depending on the class of course. Some big lectures that don't take attendance probably aren't worth going to in the first place, whereas smaller classes that do take attendance and don't use the textbook would be much harder to miss.
While working at home while doing laboratory research is not doable, my hours are flexible and I am able to shift my workload between writing/theory work and wet-lab work. So, I am in the process of closing down several of my ongoing time-intensive wet-lab experiments, shifting my daytime to writing up existing research in my apartment, and moving my labwork to be more nocturnal when fewer people are around and I am not tempted by open eateries on the campus I work at. As one of the globetrotting academic class I am way fewer degrees of separation from so many places on Earth...
Similar things could be relevant to those fortunate enough to have flexible work arrangements.
Hmm, Wikipedia tells me that Choloquine mildly suppresses the immune system, and also that it has a low theraputic index -- that is, the ratio between an effective dose and an overdose is relatively small -- and that it is "very dangerous in overdose". This does not sound like a drug that is necessarily very safe to self-administer, or recommend to people to do that, without substantial research.
EDIT: Additionally, the article you link has very little information in it. It lists a bunch of clinical trials but I can't figure out whether it's possible for me to see the results. It's not an academic paper in any real sense, just some kind of summary of other results. The only citation for the "multicenter clinical trials" given is to a press briefing by the Chinese government. There is one relevant citation to an article in Nature, but it is short and contains limited information, and is listed as a "Letter to the Editor" presumably meaning it's a preliminary result not subject to peer review.
None of this inherently means the science isn't good, but I think the risks of suggesting that people consider self-medicating with an apparently-dangerous drug are not justified by the flimsy evidence so far available.
Sorry, I wrote that in a hurry and didn't have time to report all of my reasoning. According to Wikipedia:
Hydroxychloroquine was approved for medical use in the United States in 1955. It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.
Yes the therapeutic index is low and I'm not a doctor but I don't think that mean it's easy to overdose if you follow direction. Otherwise it wouldn't be a very widely prescribed drug (in parts of the world where malaria is common). I haven't seen any reports or warnings of people overdosing after following recommended dosages (ETA: except after taking it for years). I only found accidents or suicides.
And you're right the paper is not a normal academic paper, but that is understandable given the fast moving circumstances. I do think it's pretty strong Bayesian evidence that Chloroquine and Hydroxychloroquine do more good than harm. Suppressing the immune system may be part of how it works (i.e., the immune system can do a lot of damage to one's lungs in the course of fighting infection).
Thanks for the additional info. (I think this could well be a good idea, but I think it's also good for people to know they need to be a big careful about it. E.g., to what extent do people self-prescribing chloroquine have access to good directions to follow, on how to dose it?)
The idea is that if the virus infects 40-70% of all people, the health care system will run out of resources to treat everyone, so one may be forced to stay home and self-medicate. You can also take it when you first start to get mild COVID-19 symptoms to help prevent it from getting worse, potentially saving you from a trip to the hospital even if beds are still available. As the first link says, China has been doing clinical trials with Chloroquine and the preliminary results seem promising.
note: I think it's good to update the OP answers with a summary of reasoning and whatnot so that the abridged version of the Answer section is easier to skim (and easier to evaluate how well the karma system is floating good ideas to the top)
This advice may be individually rational but seems generally quite bad from a social point of view. Don't stockpile a medicine because you think the public health system will run out of it. Same goes for stockpiling a large number of surgical masks. I've heard that hospitals and institutions in Italy already fear running out of them, and masks are crucial in these places.
The case might be different for people with high age or a preexisting condition that puts them in danger.
I used the first pharmacy, which didn't require a prescription. The FAQ on the second one says they can write most prescriptions themselves, so try contacting them and asking them to do that. If that doesn't work, try ask your health provider to write a prescription? Or sign up at the first pharmacy to be notified when Hydroxychloroquine comes back into stock. I waited about a week for it myself. After receiving the notification, stock went out again in 2 hours so look out for it.
Hi! I'm from China-yes, exactly the place where COVID-19 was born and ruined our Spring Festival completely. After months-long battle with the virus, now the confirmed case of COVID-19 has down to an alltime low. But it saddens me to see that this virus seem to spread across other countries,South Korea,Japan,Iran,Italy etc. Here I'd like to share with you some advice that Chinese goverment used to prevent the virus from infecting more people.
1.Intially, the government advised people to stay at home. But soon,the advice escalated to nearly an order. Sounds exaggerating? Not at all! , I'm from countryside where rules and regulations supposed to be the loosest. But upon receiving the order from central governemnt, all villages implemented strict control over indiidual mobility. Simply put, all villages, counties, towns and cities were doing their best to isolate themselves from others. You probably heard that the Wuhan city was locked down. Well, that is true and my heart goes to all the countryman stuck there. Many people condemned Chinese government as inhuamne and stupid. Yet given so little time , the method is by far the most efficient one! Reasons behind it is simple: STOP PHYSICAL CONTACT EQUALS STOP THE VIRUS FROM SPREADING.
2.Well, the first one is not personal suggestion. Here it is.
Why we self quarantine?
① For people who are worried that they may get infected. Self quarantine for 14 days is advised by leading doctors in China. You know, just to see if you have any symphtons:burning up, sore throat, fever etc.If you do have above symphtons, rush to hospitals at no time. Doctors and nursed are always there 24/7 fighting to save people. RESPECT to them.
②For healthy people: It's just the easiest way to make sure you are safe and sound :) (Provided that your family members are healthy as well!)
Does self quarantine means complete isolation from the outside world?
That is not the case here. I mean complete isolation is impossible in big cities. You have to stock food once in a while. So Chinese people are advised to stay at home unless it's really important things like runninggnni'nnur errands, seeing a doctor etc. And while you are out, always wear a mask.
3. MASK. MASK. MASK.
I don't know why but many westerns seemed against this. I talked to my English Coach about it and he simply said he didn't believe it would work and it looks dumb. Still, wearing a mask when you out in public can drastically reduce your chances to get infected(Plz check some videos online to learn how to wear them properly . Otherwise it's just useless) . I'm not making it up here.Its simply what I picked up from the mandatory online lessons about COVID-19. YES, it's mandatory to all students here(That's what i've heard so far). And those lessons are made by prestigious doctors and medical staff, so I belive those advice are pretty solid.
That's all. Hope they are useful and match the criteria in the article. If not, please leave me some messages and feel free to edit this text. :)
Ok, masks are the thing I am looking for advice for in the US. I do not know where to get them -- I checked Amazon and they're sold out, and my local drugstore doesn't seem to stock them at all (or are also sold out). Various advice online suggests that only n95 masks will be effective. Is that true? Talk to me more about the masks.
If N95 masks work, O95-100 and P95-100 masks should also work, and potentially be more effective - the stuff they filter is a superset of what N95 filters. They're normally more expensive, but in the current state I've actually found P100s cheaper than N95s.
Side note; I would say that the discussion conventions of LessWrong discourage copious use of emphasis with things like bold, underline or all caps. The idea is that writers should strive to convince people with their words, and not with their formatting.
I think everyone should be stocking up on at least a month of food because survival-grade food is cheap and has at least a10% chance of being very useful to you at some point, either in this pandemic or for a different emergency.
As this answer [LW(p) · GW(p)] mentions, copper tape kills diseases. And most of the spread seems to come from hand-to-surface-to-face. With those thoughts, I'm wondering if there is some sort of glove you could wear that makes spread less likely.
Gloves act as a barrier, but also as a collector. For example, if you were nursing a sick person, you would wear nitrile or latex gloves while you were in the room with them. You would remove the gloves by turning inside out from wrist (not contacting fingertips or palms) and put gloves in trash as you leave the room.
If you had gloves that you wore outside the house, you would remove the gloves before entering house.
I personally don't like single use plastic disposable gloves, but there are PU or vinyl coated reusable (washable) gloves.
I've made a few unusual purchases in recent months:
Grow some Artemesia Annua. I found seeds and tinctures, but it isn't clear if one can trust a tincture bought online. It helps to learn about the different varieties of Artemesia and the ways in which they have been tested. Combining Artemesia Annua with coffee increased its antiviral effect in lab tests.
Buy some sage smudge sticks to reduce the viral load in a house where sick people are wandering around. Lavender, rosemary, chamomile, and green teas are good traditional cold remedies. I'm not entirely sure about echinacea.
Buy a bunch of aspirin, paracetamol, and cigarettes, yes cigarettes. If there is a banking crisis or a lockdown prison environment, cigarettes are excellent currency and there is a strangely persistent negative correlation with smoking and death via the coronavirus.
Yeah, I'd ask you to make this a related question rather than an answer, it's not the right type for this thread. I'll move this to a comment and I recommend you go back up to the answer box and hit 'ask a related question'.
Should I expect a faster infection rate on my country (Brazil) because most people here use paper money to make trades? Should I recommend people to stop using paper money and instead opt for a contactless card? Most people don't have access to banking services; so is there any option for them?
It suggests that such a thing is reasonably plausible, at least, at the sorts of temperatures one might reasonably heat food to (but I think it would be very challenging to do so consistently using only a microwave oven.)
The official guideline is 60C for 30 minutes. https://www.hindawi.com/journals/av/2011/734690/ claims 56C for 15 minutes is enough. Personally, for homogenous wet stuff I would heat until close to boiling/fizzing, then wait 5 minutes and feel safe consuming.
I suspect that the rate of spread is <1 in firstworld countries. I predict that we will see a few people who have travelled abroad catch the virus. If the virus does start spreading out of control, there will be time to stock up when the numbers are in the thousands. (In the UK) I would be more worried if I was in china or south korea.
Infections tend to have exponential growth for a bit, and then stop. Current rates of growth outside china are 10X every 2 weeks. So if you need 2 weeks prep time on your practical advice, decide how much of a prob you are worried about, and divide by 10. Wait to see if the rate gets that high.
REPORT The Wuhan Virus: How to Stay Safe As China’s epidemic continues to spread, things may seem scary. Here are 10 simple precautions that can protect you from contracting the coronavirus. BY LAURIE GARRETT | JANUARY 25, 2020, 2:47 PM Laurie Garrett is a former senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer.
As the new Wuhan coronavirus has spread not only all over mainland China, but also worldwide, panic is rising. Inside China there is a growing sense of helplessness, as the government is compelled to take drastic measures to stop the virus, including introducing some travel restrictions in Beijing. I have received panicked queries from journalists and public health workers in China, asking, “How can we protect ourselves and our families?”
The epidemic could have been controlled fairly easily three weeks ago had there been more openness, swift action, and no attempted cover-up. But now it’s too late, and this virus is spreading globally. Because there is no vaccine or treatment for nCoV2019—the Wuhan pneumonia—and infection has spread throughout China, the government is forced to turn to its 2003 SARS playbook. And that means entire cities must be cut off, and the population of the nation must be restricted in its movements and potential disease-spreading behavior. It is not surprising then that travel out of Beijing may be forbidden; the entire mainland could go on lockdown soon.
I know people are very frightened. And I expect panic will rise in the coming days. But very simple measures can protect you.
During the SARS epidemic, I traveled all over China and Hong Kong, interviewed people infected with the virus, doctors and nurses treating the disease, government officials, police—everybody. I was never concerned that I would become infected, despite being in the room with sick individuals. And that’s because I knew what precautions to take. Here are the most important ones to know:
1. When you leave your home, wear gloves—winter mittens or outdoor gloves—and keep them on in subways, buses, and public spaces.
2. If you are in a social situation where you should remove your gloves, perhaps to shake hands or dine, do not touch your face or eyes, no matter how much something itches. Keep your hands away from contact with your face. And before you put your gloves back on, wash your hands thoroughly with soap and warm water, scrubbing the fingers. Put your gloves on.
3. Change gloves daily, washing them thoroughly, and avoid wearing damp gloves.
4. Masks are useless when worn outdoors and may not be very helpful even indoors. Most masks deteriorate after one or two wearings. Using the same mask day after day is worse than useless—it’s disgusting, as the contents of your mouth and nose eventually coat the inside of the mask with a smelly veneer that is attractive to bacteria. I rarely wear a face mask in an epidemic, and I have been in more than 30 outbreaks. Instead, I stay away from crowds, and I keep my distance from individual people—a half meter, about 1.5 feet, is a good standard. If someone is coughing or sneezing, I ask them to put on a mask—to protect me from their potentially contaminated fluids. If they decline, I step a meter (about 3 feet) away from them, or I leave. Don’t shake hands or hug people—politely beg off, saying it’s better for both of you not to come in close contact during an epidemic.
5. Inside your household, remove all of the towels from your bathrooms and kitchen immediately, and replace them with clean towels that have the names of each family member on them. Instruct everybody in your home to only use their own towels and never touch another family member’s. Wash all towels twice a week. Damp towels provide terrific homes for viruses, like common colds, flus, and, yes, coronaviruses.
6. Be careful with doorknobs. If it’s possible to open and close doors using your elbows or shoulders, do so. Wear gloves to turn a doorknob—or wash your hands after touching it. If anybody in your home takes sick, wash your doorknobs regularly. Similarly, be cautious with stairway banisters, desktops, cell phones, toys, laptops—any objects that are hand-held. As long as you handle only your own personal objects, you will be ok—but if you need to pick up someone else’s cell phone or cooking tools or use someone else’s computer keyboard, be mindful of not touching your face and wash your hands immediately after touching the object.
7. If you share meals, do not use your personal chopsticks and utensils to remove food from a serving bowl or plate and, of course, tell your children to never drink out of anybody else’s cups or from a container of shared fluid. It is customary in China to prepare several dishes for a meal and then allow everybody at the table to use their personal chopsticks to pull food from the common dishes: Don’t do this until the epidemic is over. Place serving spoons in each dish and instruct everybody at the table to scoop what they want from the serving dishes onto their personal plates or bowls, return the serving spoon to the main dish, and then use their personal chopsticks only to pick food from their personal plate or bowl into their mouth. Wash all food and kitchenware thoroughly between meals and avoid restaurants that have poor hygiene practices.
8. Absolutely do not buy, slaughter, or consume any live animal or fish until it is known what species was the source of the virus.
9. When the weather allows, open your windows at home or work, letting your space air out. The virus cannot linger in a well-ventilated space. But of course, if it is cold or the weather is inclement, keep warm and close those windows.
10. Finally, if you are caring for a friend or family member who is running a fever, always wear a tight-fitting mask when you are near them, and place one on the ailing person (unless they are nauseated). When you replace an old, dirty mask from the face of your friend or loved one be very, very careful—assume, for the sake of your protection, that it is covered in viruses, and handle it while wearing latex gloves, place it inside of a disposable container, seal it, and then put it in the trash. While wearing those latex gloves, gently wash the patient’s face with warm soap and water, using a disposable paper towel or cotton swab, and seal it after use in a container or plastic bag before placing it in your household trash. Wear long-sleeved shirts and clothing that covers your body when you are caring for your ailing friend or relative. Clean everything your patient wears or touches very thoroughly in hot soapy water, including sheets, towels, and utensils. If you have space, isolate the sick person in your household in a room, or a corner of a room, where they are comfortable, but separated from the rest of the household. If the weather is tolerable, open a window that is on the opposite side of the room, so that air gently blows past the patient’s face and then outdoors. Of course, don’t do this if it is very cold, as your friend or loved one will be made sicker if uncomfortably cold. The Chinese government will take very drastic actions over the next few weeks, and this will be a time of hardship for the Chinese people. As the virus spreads in other countries, similarly draconian measures may be invoked to slow the epidemic. But with these simple precautions, if taken by everybody in your household, building, office, and school, you will dramatically reduce the spread of the virus and bring the outbreak to its knees.
Be safe. Do not panic. Take commonsense precautions. As frightening as this time is, you will get through it.
Laurie Garrett is a former senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer.
James Robb, MD FCAP
Date: February 26, 2020 at 2:35:50 PM EST Subject: What I am doing for the upcoming COVID-19 (coronavirus) pandemic. Dear Colleagues, as some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources. The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April. Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves.: 1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc. 2) Use ONLY your knuckle to touch light switches. elevator buttons, etc.. Lift the gasoline dispenser with a paper towel or use a disposable glove. 3) Open doors with your closed fist or hip – do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors. 4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts. 5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been. 6) Keep a bottle of sanitizer available at each of your home’s entrances. AND in your car for use after getting gas or touching other contaminated objects when you can’t immediately wash your hands. 7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!
What I have stocked in preparation for the pandemic spread to the US: 1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas. Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average – everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth. 2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you – it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth – it is only to keep you from touching your nose or mouth. 3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective. 4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY “cold-like” symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available. I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available. I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share this email. Good luck to all of us! Jim James Robb, MD FCAP
+++++++++++++++++++++ Dr. Robb is a recognized expert in biospecimen science with over 50 years of experience in molecular pathology, virology, and genetics. He is board certified in anatomic pathology, clinical pathology, cytopathology, and dermatopathology. Dr. Robb is a consulting pathologist to the National Cancer Institute (NCI) and the Office of Biorepositories and Biospecimen Research (OBBR). He served as a member of the council on scientific affairs, the CSA Education Working Group, the Council on Education, the Personalized Health Care Committee, the Ad Hoc Committee on Pathology Report Standardization, and the CSA Working Group on Informed Consent for Biospecimens. He was the leader of the NCI’s Cancer Human Biobank (caHUB) Biospecimens Subgroup, NCI’s US-Latin America Cancer Research Network (US-LA CRN) Pathology Committee, and National Community Cancer Center Program (NCCCP). Dr. Robb was the governor of the College of American Pathologists (CAP) Informatics committee, an organization comprising of over 18,000 board-certified pathologists.
Dr. Robb, graduated with a BA in theoretical physics from the University of Colorado. He then enrolled at School of Medicine at the University of Colorado Medical School in 1965, and earned his MD degree with honors. He completed his pathology residency and molecular biology training at the Yale University and went on to become a senior surgeon at NIH. After NIH, he moved to the Department of Pathology, University of California San Diego (UCSD); worked as a staff pathologist at Scripps Clinic, La Jolla, California; and lately served as the Director of Anatomic and Molecular Pathology, Cedars MC, Miami, Florida. Dr. Robb’s research interests include molecular oncologic and neurotropic virology.
I am considering buying a household ozonizer. Only good quality ozonizer (there are many of them on the market, but they provide insufficient concentration). Household ozonizers have a double effect: 1. Kill viruses and bacteria in the room, also preventing their reproduction and spread 2. Through breathing saturate the blood with ozone (O3), which enhances natural immunity. In addition to air ozonation, there is also ozonation of water and oils - for gargling and drinking/food preparation. When choosing an ozonizer as the "baseline", I consider the effectiveness of ozone when exposed to the influenza virus: it is argued that the virus dies 100% with an ozone concentration of 0.2 mg / m³ and an exposure of 60 minutes - this is much more effective than under the influence of bleach and quartz irradiation (by the way, buying a quartz lamp is also one of the options, possibly cheaper). As for the models, the requirements satisfy - 1. "Living Air”, USA, EcoQuest, Fresh Air Model 2. Ukrainian ozonizer "Ozone OViV" 3. Hungarian ozonizer Bionet "SELBA", SM-316 and probably some more. In Ukraine, the price for the corresponding ozonizer is $ 200-400 (depending on the model).
In the US, "NO agency of the federal government has approved these devices for use in occupied spaces. Because of these claims, and because ozone can cause health problems at high concentrations, several federal government agencies have worked in consultation with the U.S. Environmental Protection Agency to produce this public information document."
"When inhaled, ozone can damage the lungs. Relatively low amounts can cause chest pain, coughing, shortness of breath and throat irritation. Ozone may also worsen chronic respiratory diseases such as asthma and compromise the ability of the body to fight respiratory infections. "